TY - JOUR AU - de Vette, Frederiek AU - Ruiz-Rodriguez, Aurora AU - Tabak, Monique AU - Oude Nijeweme-d'Hollosy, Wendy AU - Hermens, Hermie AU - Vollenbroek-Hutten, Miriam PY - 2024/11/8 TI - Developing Game-Based Design for eHealth in Practice: 4-Phase Game Design Process JO - JMIR Form Res SP - e13723 VL - 8 KW - game based KW - gamification KW - game KW - eHealth KW - telemedicine KW - development KW - design KW - engagement KW - game preferences KW - older adults KW - self-management KW - prototyping KW - evaluations KW - creative N2 - 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. UR - https://formative.jmir.org/2024/1/e13723 UR - http://dx.doi.org/10.2196/13723 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/13723 ER - TY - JOUR AU - Courtney, Elizabeth Kelly AU - Liu, Weichen AU - Andrade, Gianna AU - Schulze, Jurgen AU - Doran, Neal PY - 2024/6/27 TI - Attentional Bias, Pupillometry, and Spontaneous Blink Rate: Eye Characteristic Assessment Within a Translatable Nicotine Cue Virtual Reality Paradigm JO - JMIR Serious Games SP - e54220 VL - 12 KW - nicotine KW - craving KW - cue exposure KW - virtual reality KW - attentional bias KW - pupillometry KW - spontaneous blink rate KW - eye-tracking KW - tobacco KW - VR KW - development KW - addiction KW - eye KW - pupil KW - biomarker KW - biomarkers KW - tobacco product N2 - Background: Incentive salience processes are important for the development and maintenance of addiction. Eye characteristics such as gaze fixation time, pupil diameter, and spontaneous eyeblink rate (EBR) are theorized to reflect incentive salience and may serve as useful biomarkers. However, conventional cue exposure paradigms have limitations that may impede accurate assessment of these markers. Objective: This study sought to evaluate the validity of these eye-tracking metrics as indicators of incentive salience within a virtual reality (VR) environment replicating real-world situations of nicotine and tobacco product (NTP) use. Methods: NTP users from the community were recruited and grouped by NTP use patterns: nondaily (n=33) and daily (n=75) use. Participants underwent the NTP cue VR paradigm and completed measures of nicotine craving, NTP use history, and VR-related assessments. Eye-gaze fixation time (attentional bias) and pupillometry in response to NTP versus control cues and EBR during the active and neutral VR scenes were recorded and analyzed using ANOVA and analysis of covariance models. Results: Greater subjective craving, as measured by the Tobacco Craving Questionnaire?Short Form, following active versus neutral scenes was observed (F1,106=47.95; P<.001). Greater mean eye-gaze fixation time (F1,106=48.34; P<.001) and pupil diameter (F1,102=5.99; P=.02) in response to NTP versus control cues were also detected. Evidence of NTP use group effects was observed in fixation time and pupillometry analyses, as well as correlations between these metrics, NTP use history, and nicotine craving. No significant associations were observed with EBR. Conclusions: This study provides additional evidence for attentional bias, as measured via eye-gaze fixation time, and pupillometry as useful biomarkers of incentive salience, and partially supports theories suggesting that incentive salience diminishes as nicotine dependence severity increases. UR - https://games.jmir.org/2024/1/e54220 UR - http://dx.doi.org/10.2196/54220 ID - info:doi/10.2196/54220 ER - TY - JOUR AU - Bunt, Lance AU - Greeff, Japie AU - Taylor, Estelle PY - 2024/5/31 TI - Enhancing Serious Game Design: Expert-Reviewed, Stakeholder-Centered Framework JO - JMIR Serious Games SP - e48099 VL - 12 KW - serious games KW - stakeholder theory KW - enterprise architecture KW - serious game development KW - design framework N2 - 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. UR - https://games.jmir.org/2024/1/e48099 UR - http://dx.doi.org/10.2196/48099 UR - http://www.ncbi.nlm.nih.gov/pubmed/38820585 ID - info:doi/10.2196/48099 ER - TY - JOUR AU - Abraham, Olufunmilola AU - McCarthy, J. Tyler PY - 2024/5/29 TI - An Introduction to the OutSMART Cancer Serious Game: Current and Future Directions JO - JMIR Cancer SP - e56168 VL - 10 KW - serious game KW - cancer KW - health education KW - adolescents KW - health behavior KW - United States KW - young people KW - adolescent KW - teenager KW - teenagers KW - cancer prevention KW - education KW - cancer risk KW - tool KW - OutSMART Cancer KW - innovative KW - game development KW - cancer awareness KW - prevention KW - wellness UR - https://cancer.jmir.org/2024/1/e56168 UR - http://dx.doi.org/10.2196/56168 UR - http://www.ncbi.nlm.nih.gov/pubmed/38809587 ID - info:doi/10.2196/56168 ER - TY - JOUR AU - Novak, Daniel PY - 2024/5/7 TI - A Serious Game (MyDiabetic) to Support Children?s Education in Type 1 Diabetes Mellitus: Iterative Participatory Co-Design and Feasibility Study JO - JMIR Serious Games SP - e49478 VL - 12 KW - diabetes mellitus KW - serious games KW - mobile app KW - co-design KW - user-centered design KW - serious game KW - gaming KW - diabetes KW - child with diabetes KW - child KW - children KW - insulin KW - glucometer KW - glucose KW - patient education KW - mobile phone N2 - Background: Serious games, which are gaming applications used for purposes beyond entertainment to educate users on, and address, specific issues, may present a timely approach to promote healthy diabetes management behaviors among children with type 1 diabetes mellitus (T1DM). The lasting benefits associated with these serious games encompass improved patient education; enhanced glycemic control; the reinforcement of bonds within the community of people with diabetes; the facilitation of meaningful dialogues with caregivers, especially within the familial setting; and a significant reduction in the economic burdens associated with subsequent complications. Objective: This paper primarily aims to provide a detailed overview of the iterative design process and the associated evaluation methods used in the development of the educational game. Furthermore, this study aims to enhance motivation for sustained and extended engagement with the game over time. The MyDiabetic game design aims to educate children on various aspects, including the connections among food, insulin, and physical activity. Furthermore, it seeks to impart knowledge related to the operation of a glucometer and an insulin pen, as well as more advanced technologies such as administering glucagon, measuring ketoacidosis, and continuous glucose monitoring. Methods: The co-design methodology was applied, involving interviews, design workshops, and prototype feedback sessions. A combination of several approaches, such as tailoring, observational learning, social and family support, decision-making practice, and reward systems, was used to support children?s compliance. Moreover, incorporating the literature, guidelines, and current practices into the design ensured that the game was aligned with established health care pathways and included relevant information and best practices for diabetes management. Results: The game was tested on 32 children in 3 iterations. Positive responses were received from children who tested the game as well as their parents. The game was also presented to 5 schoolmates of children with T1DM who appreciated a better understanding of the disease and the opportunity to support their friends more efficiently in T1DM compensation. The involvement of children and clinicians in participatory co-design contributed to to the game's high acceptance. With regard to the game?s impact on education, 1 week of testing revealed an enhancement in educational outcomes. Conclusions: The game is especially suitable for children newly diagnosed with T1DM because it acquaints them in a fun way with new terminology; for example, they can try to measure glycemia levels in an interactive way. The game also caters to children who still need to develop reading skills by including an audio guide. The guide ensures that children of all literacy levels can benefit from the game?s educational content and interactive experiences. The game is available for download on Google Play and the Apple App Store. UR - https://games.jmir.org/2024/1/e49478 UR - http://dx.doi.org/10.2196/49478 UR - http://www.ncbi.nlm.nih.gov/pubmed/38713496 ID - info:doi/10.2196/49478 ER - TY - JOUR AU - Labrosse, David AU - Vié, Clara AU - Hajjam, Hana AU - Tisseron, Clément AU - Thellier, Dimitri AU - Montagni, Ilaria PY - 2024/3/18 TI - An Escape Game on University Students? Mental Health During the COVID-19 Pandemic: Cocreation Study JO - JMIR Serious Games SP - e48545 VL - 12 KW - students KW - game KW - mental health KW - COVID-19 KW - cocreation KW - university student KW - promote KW - psychological well-being KW - effective tool KW - tool KW - acceptability KW - testing KW - questionnaire KW - learning KW - motivation KW - user centered N2 - Background: The COVID-19 pandemic has had a severe impact on students? mental health. Interventions are needed to promote their psychological well-being and prevent mental illnesses in the aftermath of this unprecedented situation. Digital escape games can be an effective tool to support students? mental health. A cocreation approach can improve the acceptability of these interventions by involving different stakeholders (eg, end users, game designers, and health professionals) to obtain audience-specific games. Objective: This study aims to describe the process of testing and optimizing the game ?EscapeCovid? on students? mental health, to serve as a model for the cocreation of future similar interventions. Methods: The PRODUCES (Problem, Objective, Design, End Users, Cocreators, Evaluation, Scalability) framework was used. Cocreation steps (test and optimization) were detailed for replicability. A total of 45 students tested a pilot version of the game, with 10 undergoing a semistructured interview. Meetings with a group of stakeholders and brainwriting were organized to optimize the game. Results: We produced a new version of the game incorporating the suggestions provided by student testers and following the stakeholders? guidelines. Improvements were made to both the content and the form of the new version of the pilot game. The storyline, including the protagonist and the scenes, was adapted to the student population. Conclusions: Our results suggested that cocreation can contribute to the design of more widely accepted interventions aimed at promoting mental health and preventing psychological disorders. Results also suggest that an end user?centered approach can facilitate intervention tailoring. When conceiving a health-related escape game for students, we recommend using the cocreation approach to enhance players? experience, thus positively influencing their learning process and overall well-being. UR - https://games.jmir.org/2024/1/e48545 UR - http://dx.doi.org/10.2196/48545 UR - http://www.ncbi.nlm.nih.gov/pubmed/38498033 ID - info:doi/10.2196/48545 ER - TY - JOUR AU - Atagbuzia, Chukwudiebube AU - Ng, H. Ean AU - Natarajan, Ganapathy PY - 2024/3/12 TI - Improving Behavioral-Based Safety Training in Using Verbal Commands Through a Theory-Driven and Feedback-Based Nonimmersive Virtual Reality Game: Development and Usability Study JO - JMIR Form Res SP - e48080 VL - 8 KW - behavioral safety training KW - SERES framework KW - Reflection, Engagement, Choice, Information, Play, Exposition framework KW - gamification KW - gestalt laws of perception N2 - Background: The construction, chemical, aviation, medical, and health care industries have used serious games for safety training. To our knowledge, serious games have not been developed focusing on behavioral change to improve safety through the use of verbal commands and instilling players with heightened awareness of their spatial proximity to other people in their surroundings. Objective: We aimed to develop a theory-driven serious game for improving safety behavior using verbal commands and validate the implementation of the theoretical frameworks used for game development. The game developed, KitchenSpeak, was a first-person character (FPC) game where users respond to in-game prompts to use loud verbal commands when they are approaching another employee?s blind spot. Methods: In addition to using the SERES framework in guiding the general game design and development, and the Reflection, Engagement, Choice, Information, Play, Exposition (RECIPE) framework to inform the design of the game mechanics, we also applied gestalt laws of perception for graphic design to guide the design of the game?s user interface. We conducted 2 evaluative tests (alpha and beta) to collect end user and stakeholder feedback on the implementation of the theoretical frameworks, as well as to collect relevant information for full-scale implementation and a future validation study. Results: The alpha and beta tests had 8 and 40 participants, respectively. The alpha test results revealed that the theoretical frameworks were adequately applied; however, suggestions were also made to modify and improve the game. The beta test results suggested further improvements for the game design and found no differences in the perception of ease of play between participants with and without previous FPC gaming experience (P=.47; Kruskal-Wallis). Results suggested that the game met its design and theoretical requirements, and it would be easily playable by all players regardless of their previous experience in FPC games. Conclusions: A theory-driven and evidence-based FPC game titled KitchenSpeak was developed to teach the use of kitchen-speak terms in commercial kitchens. Evaluative tests were conducted to validate the implementation of the theoretical frameworks. Our main contributions are creating and validating game-based training to improve behavioral-based safety in the workplace and the incorporation of gestalt laws of perception for graphic design in the game?s user interface. UR - https://formative.jmir.org/2024/1/e48080 UR - http://dx.doi.org/10.2196/48080 UR - http://www.ncbi.nlm.nih.gov/pubmed/38470470 ID - info:doi/10.2196/48080 ER - TY - JOUR AU - Cheng, Xiangyi AU - Gilmore, C. Grover AU - Lerner, J. Alan AU - Lee, Kiju PY - 2023/5/16 TI - Computerized Block Games for Automated Cognitive Assessment: Development and Evaluation Study JO - JMIR Serious Games SP - e40931 VL - 11 KW - cognitive assessment KW - computerized block games KW - adaptive serious games KW - computerized cognitive assessment N2 - Background: Cognitive assessment using tangible objects can measure fine motor and hand-eye coordination skills along with other cognitive domains. Administering such tests is often expensive, labor-intensive, and error prone owing to manual recording and potential subjectivity. Automating the administration and scoring processes can address these difficulties while reducing time and cost. e-Cube is a new vision-based, computerized cognitive assessment tool that integrates computational measures of play complexity and item generators to enable automated and adaptive testing. The e-Cube games use a set of cubes, and the system tracks the movements and locations of these cubes as manipulated by the player. Objective: The primary objectives of the study were to validate the play complexity measures that form the basis of developing the adaptive assessment system and evaluate the preliminary utility and usability of the e-Cube system as an automated cognitive assessment tool. Methods: This study used 6 e-Cube games, namely, Assembly, Shape-Matching, Sequence-Memory, Spatial-Memory, Path-Tracking, and Maze, each targeting different cognitive domains. In total, 2 versions of the games, the fixed version with predetermined sets of items and the adaptive version using the autonomous item generators, were prepared for comparative evaluation. Enrolled participants (N=80; aged 18-60 years) were divided into 2 groups: 48% (38/80) of the participants in the fixed group and 52% (42/80) in the adaptive group. Each was administered the 6 e-Cube games; 3 subtests of the Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV; Block Design, Digit Span, and Matrix Reasoning); and the System Usability Scale (SUS). Statistical analyses at the 95% significance level were applied. Results: The play complexity values were correlated with the performance indicators (ie, correctness and completion time). The adaptive e-Cube games were correlated with the WAIS-IV subtests (r=0.49, 95% CI 0.21-0.70; P<.001 for Assembly and Block Design; r=0.34, 95% CI 0.03-0.59; P=.03 for Shape-Matching and Matrix Reasoning; r=0.51, 95% CI 0.24-0.72; P<.001 for Spatial-Memory and Digit Span; r=0.45, 95% CI 0.16-0.67; P=.003 for Path-Tracking and Block Design; and r=0.45, 95% CI 0.16-0.67; P=.003 for Path-Tracking and Matrix Reasoning). The fixed version showed weaker correlations with the WAIS-IV subtests. The e-Cube system showed a low false detection rate (6/5990, 0.1%) and was determined to be usable, with an average SUS score of 86.01 (SD 8.75). Conclusions: The correlations between the play complexity values and performance indicators supported the validity of the play complexity measures. Correlations between the adaptive e-Cube games and the WAIS-IV subtests demonstrated the potential utility of the e-Cube games for cognitive assessment, but a further validation study is needed to confirm this. The low false detection rate and high SUS scores indicated that e-Cube is technically reliable and usable. UR - https://games.jmir.org/2023/1/e40931 UR - http://dx.doi.org/10.2196/40931 UR - http://www.ncbi.nlm.nih.gov/pubmed/37191993 ID - info:doi/10.2196/40931 ER - TY - JOUR AU - Sriwatanathamma, Poe AU - Sirivesmas, Veerawat AU - Simatrang, Sone AU - Bhowmik, Himani Nobonita PY - 2023/5/12 TI - Gamifying Cognitive Behavioral Therapy Techniques on Smartphones for Bangkok?s Millennials With Depressive Symptoms: Interdisciplinary Game Development JO - JMIR Serious Games SP - e41638 VL - 11 KW - cognitive behavioral therapy KW - gamification KW - Bangkok?s millennials KW - depressive symptoms KW - mobile phone N2 - Background: There is serious concern over the annual increase in depressive symptoms among millennials in Bangkok, Thailand. Their daily routine revolves around the use of their smartphones for work and leisure. Although accessibility to mental health care is expanding, it cannot keep up with the demand for mental health treatment. Outside Thailand, multiple projects and studies have attempted to merge gamification mechanisms and cognitive behavioral therapy (CBT) to create mobile health intervention apps and serious games with positive feedback. This presents an opportunity to explore the same approach in Thailand. Objective: This study investigated the development process of gamifying CBT techniques to support game mechanics in a visual narrative serious game, BlueLine. The primary target of this research is Bangkok?s millennials. In the game, players play as Blue, a Bangkok millennial who struggles to live through societal norms that influence his digital life and relationships. Through in-game scenarios, players will learn and understand how to lessen the impact of depressive symptoms via gamified interactions on their smartphones. Methods: First, this paper follows each development step of solidifying BlueLine?s game structure by integrating the Activating Events, Beliefs, Consequences, Disputation of Beliefs and Effective New Approaches (ABCDE) model and narrative in games. Second, the approach to select CBT and related therapeutic elements for gamification is based on suitability to the game structure. Throughout the process, CBT experts in Thailand have reviewed these scenarios. The approach forms the base of the player?s interactions throughout the scenarios in BlueLine, broken down into 4 types of gamified mechanisms: narrative, verbal interactions, physical interactions, and social media interactions. Results: With the game structure based on the ABCDE model, BlueLine scenarios implement gamified mechanisms in conjunction with the following CBT and related therapeutic elements: behavioral activation, self-monitoring, interpersonal skills, positive psychology, relaxation and mindful activities, and problem-solving. In each scenario, players guide Blue to overcome his triggered dysfunctional beliefs. During this process, players can learn and understand how to lessen the impact of depressive symptoms through gamified interactions. Conclusions: This paper presents the development process of gamifying CBT and related therapeutic techniques in BlueLine game scenarios. A scenario can harbor multiple techniques, including behavioral activation, self-monitoring, interpersonal skills, positive psychology, relaxation and mindful activities, and problem-solving. BlueLine?s game structure does not limit the fact that the same combination of CBT elements ties each gamified mechanism. UR - https://games.jmir.org/2023/1/e41638 UR - http://dx.doi.org/10.2196/41638 UR - http://www.ncbi.nlm.nih.gov/pubmed/37171845 ID - info:doi/10.2196/41638 ER - TY - JOUR AU - Saiger, John Michael AU - Deterding, Sebastian AU - Gega, Lina PY - 2023/3/16 TI - Children and Young People?s Involvement in Designing Applied Games: Scoping Review JO - JMIR Serious Games SP - e42680 VL - 11 KW - serious game KW - game design KW - end user KW - participatory design KW - co-design KW - user involvement method KW - interventions KW - game development KW - children KW - pediatric KW - young people KW - child KW - youth KW - review method KW - scoping KW - applied game N2 - Background: User involvement is widely accepted as key for designing effective applied games for health. This especially holds true for children and young people as target audiences, whose abilities, needs, and preferences can diverge substantially from those of adult designers and players. Nevertheless, there is little shared knowledge about how concretely children and young people have been involved in the design of applied games, let alone consensus guidance on how to do so effectively. Objective: The aim of this scoping review was to describe which user involvement methods have been used in the design of applied games with children and young people, how these methods were implemented, and in what roles children and young people were involved as well as what factors affected their involvement. Methods: We conducted a systematic literature search and selection across the ACM Digital Library, IEEE Xplore, Scopus, and Web of Science databases using State of the Art through Systematic Review software for screening, selection, and data extraction. We then conducted a qualitative content analysis on the extracted data using NVivo. Results: We retrieved 1085 records, of which 47 (4.33%) met the eligibility criteria. The chief involvement methods were participatory design (20/47, 43%) and co-design (16/47, 37%), spanning a wide range of 45 concrete activities with paper prototyping, group discussions, and playtesting being the most frequent. In only half of the studies (24/47, 51%), children and young people participated as true design partners. Our qualitative content analysis suggested 5 factors that affect their successful involvement: comprehension, cohesion, confidence, accessibility, and time constraints. Conclusions: Co-design, participatory design, and similar high-level labels that are currently used in the field gloss over very uneven degrees of participation in design and a wide variety of implementations that greatly affect actual user involvement. This field would benefit from more careful consideration and documentation of the reason of user involvement. Future research should explore concrete activities and configurations that can address the common challenges of involving children and young people, such as comprehension, cohesion, confidence, and accessibility. UR - https://games.jmir.org/2023/1/e42680 UR - http://dx.doi.org/10.2196/42680 UR - http://www.ncbi.nlm.nih.gov/pubmed/36928258 ID - info:doi/10.2196/42680 ER - TY - JOUR AU - Kermavnar, Tja?a AU - Visch, T. Valentijn AU - Desmet, A. Pieter M. PY - 2023/3/7 TI - Games in Times of a Pandemic: Structured Overview of COVID-19 Serious Games JO - JMIR Serious Games SP - e41766 VL - 11 KW - COVID-19 KW - serious game KW - game-based intervention N2 - Background: The COVID-19 pandemic introduced an urgent need for effective strategies to disseminate crucial knowledge and improve people?s subjective well-being. Complementing more conventional approaches to knowledge dissemination, game-based interventions were developed to create awareness and educate people about the pandemic, hoping to change their attitudes and behavior. Objective: This study provided an overview and analysis of digital and analog game-based interventions in the context of the COVID-19 pandemic. As major pandemics and other large-scale disruptive events are expected to increase in frequency in the coming decades, this analysis aimed to inform the design, uptake, and effects of similar future interventions. Methods: From November 2021 to April 2022, Scopus, Google, and YouTube were searched for articles and videos describing COVID-19?themed game-based interventions. Information regarding authorship, year of development or launch, country of origin, license, deployment, genre or type, target audience, player interaction, in-game goal, and intended transfer effects was extracted. Information regarding intervention effectiveness was retrieved where possible. Results: A diverse assortment of 23 analog and 43 digital serious games was identified, approximately one-third of them (25/66, 38%) through scientific articles. Most of these games were developed by research institutions in 2020 (13/66, 20%) and originated in Europe and North America (38/66, 58%). A limited number (20/66, 30%) were tested on relatively small samples, using a diversity of research methods to assess the potential changes in participants? knowledge, attitudes, and behaviors as well as their gameplay experience. Although most of the evaluated games (11/20, 55%) effectively engaged and motivated the players, increased awareness, and improved their understanding of COVID-19?related issues, the games? success in influencing people?s behavior was often unclear or limited. Conclusions: To increase the impact of similar future interventions aimed at disseminating knowledge and influencing people?s attitudes and behaviors during a large-scale crisis, some considerations are suggested. On the basis of the study results and informed by existing game theories, recommendations are made in relation to game development, deployment, and distribution; game users, design, and use; game design terminology; and effectiveness testing for serious games. UR - https://games.jmir.org/2023/1/e41766 UR - http://dx.doi.org/10.2196/41766 UR - http://www.ncbi.nlm.nih.gov/pubmed/36634265 ID - info:doi/10.2196/41766 ER - TY - JOUR AU - Perrin, Julien AU - Meeus, Amélie AU - Broseus, Julien AU - Morieux, Pierre-Jean AU - Di Ceglie, Valentine AU - Gravoulet, Julien AU - D'Aveni, Maud PY - 2023/2/13 TI - A Serious Game About Hematology for Health Care Workers (SUPER HEMO): Development and Validation Study JO - JMIR Serious Games SP - e40350 VL - 11 KW - educational technology KW - hematology KW - health care students KW - education KW - teaching KW - validation KW - methodological study KW - video support tool KW - continuing education KW - serious games KW - educational games N2 - Background: Complete blood count (CBC) and hemostatic screening tests are among the most commonly prescribed blood tests worldwide. All health care workers (nurse practitioners, pharmacists, dentists, midwives, and physicians) are expected to correctly interpret the results in their daily practice. Currently, the undergraduate hematology curriculum consists predominantly of lecture-based teaching. Because hematology combines basic science (blood cells and hemostasis physiology) and clinical skills, students report that they do not easily master hematology with only lecture-based teaching. Having interviewed students at the University of Lorraine, we considered it necessary to develop new teaching approaches and methods. Objective: We aimed to develop and validate a serious game about CBC analysis for health care students. Our primary objective was to help students perceive hematology as being a playful and easy topic and for them to feel truly involved in taking care of their patients by analyzing blood tests. We considered that this game-based approach would be attractive to students as an addition to the classic lecture-based approach and improve their knowledge and skills in hematology. Methods: We developed an adventure game called SUPER HEMO, a video game in which the player assumes the role of a protagonist in an interactive story driven by exploration and problem-solving tests. Following validation with beta testing by a panel of volunteer students, we used a novel, integrated teaching approach. We added 1.5 hours of gaming to the standard curriculum for a small group of volunteer students. Physician and pharmacy students in their third year at a single French university were invited to attend this extracurricular course. Pregame and postgame tests and satisfaction surveys were immediately recorded. Final hematology exam results were analyzed. Results: A total of 86 of 324 physician students (26.5%) and 67 of 115 pharmacy students (58%) opted to participate. Median scores on the pre- and posttests were 6 out of 10 versus 7 out of 10, respectively, for the physician students, (P<.001) and 7.5 out of 10 versus 8 out of 10, respectively, for the pharmacy students (P<.001). At the final hematology evaluation, physician students who played SUPER HEMO had a slightly better median score than those who did not: 13 out of 20 versus 12 out of 20, respectively (P=.002). Pharmacy students who played SUPER HEMO had a median score of 21.75 out of 30; this was not significantly different from pharmacy students who did not play SUPER HEMO (20/30; P=.12). Among the participants who answered the survey (n=143), more than 86% (123/143) believed they had strengthened their knowledge and nearly 80% (114/143) of them had fun. Conclusions: Feedback from this game session provided evidence to support the integration of interactive teaching methods in undergraduate hematology teaching. The development of SUPER HEMO is intended to be completed so that it can become a support tool for continuing education. UR - https://games.jmir.org/2023/1/e40350 UR - http://dx.doi.org/10.2196/40350 UR - http://www.ncbi.nlm.nih.gov/pubmed/36780215 ID - info:doi/10.2196/40350 ER - TY - JOUR AU - Kim, Hyungsook AU - O'Sullivan, Michael David AU - Chung, Hee Seong PY - 2022/12/16 TI - Applying Gamification Principles and Therapeutic Movement Sequences to Design an Interactive Physical Activity Game: Development Study JO - JMIR Serious Games SP - e38133 VL - 10 IS - 4 KW - home workout KW - mobile assistant KW - movement KW - physical activity KW - depression N2 - Background: Depression is a severe illness that has accelerated with the spread of COVID-19 and associated lockdowns. As a result, reported physical activity has substantially decreased, further increasing depressive symptoms. Objective: This study aims to explain the use of gamification principles to develop content for an interactive physical activity game for depression based on clinically proven depression diagnostic criteria. Methods: We discuss related work in this field, the game design framework, the users? depression severity, how we customize the contents accordingly, the gradual progression of the game to match exercise principles, and user flow optimization. Results: We provide a brief description of each of the games developed, including instructions on how to play and design aspects for flow, audio, and visual feedback methods. Exergames (interactive physical activity?based games) stimulate certain physical fitness factors such as improving reaction time, endurance, cardiovascular fitness, and flexibility. In addition, the game difficulty progresses based on various factors, such as the user?s performance for successful completion, reaction time, movement speed, and stimulated larger joint range of motions. Cognitive aspects are included, as the user has to memorize particular movement sequences. Conclusions: Mental health issues are linked to behavior and movement; therefore, future physical activity?based interactive games may provide excellent stimulation for inducing user flow, while physical activity can help train various physical fitness factors linked to depression. UR - https://games.jmir.org/2022/4/e38133 UR - http://dx.doi.org/10.2196/38133 UR - http://www.ncbi.nlm.nih.gov/pubmed/36525298 ID - info:doi/10.2196/38133 ER - TY - JOUR AU - Kim, Sang Yoon AU - Won, JuHye AU - Jang, Seong-Wook AU - Ko, Junho PY - 2022/10/17 TI - Effects of Cybersickness Caused by Head-Mounted Display?Based Virtual Reality on Physiological Responses: Cross-sectional Study JO - JMIR Serious Games SP - e37938 VL - 10 IS - 4 KW - cybersickness KW - physiological responses KW - virtual reality KW - VR KW - head-mounted displays KW - heart rate KW - cortisol N2 - Background: Although more people are experiencing cybersickness due to the popularization of virtual reality (VR), no official standard for the cause and reduction of cybersickness exists to date. One of the main reasons is that an objective method to assess cybersickness has not been established. To resolve this, research on evaluating cybersickness with physiological responses that can be measured in real time is required. Since research on deriving physiological responses that can assess cybersickness is at an early stage, further studies examining various physiological responses are needed. Objective: This study analyzed the effects of cybersickness caused by head-mounted display?based VR on physiological responses. Methods: We developed content that provided users with a first-person view of an aircraft that moved (with translation and combined rotation) over a city via a predetermined trajectory. In the experiment, cybersickness and the physiological responses of participants were measured. Cybersickness was assessed by the Simulator Sickness Questionnaire (SSQ). The measured physiological responses were heart rate, blood pressure, body temperature, and cortisol level. Results: Our measurement confirmed that all SSQ scores increased significantly (all Ps<.05) when participants experienced cybersickness. Heart rate and cortisol level increased significantly (P=.01 and P=.001, respectively). Body temperature also increased, but there was no statistically significant difference (P=.02). Systolic blood pressure and diastolic blood pressure decreased significantly (P=.001). Conclusions: Based on the results of our analysis, the following conclusions were drawn: (1) cybersickness causes significant disorientation, and research on this topic should focus on factors that affect disorientation; and (2) the physiological responses that are suitable for measuring cybersickness are heart rate and cortisol level. UR - https://games.jmir.org/2022/4/e37938 UR - http://dx.doi.org/10.2196/37938 UR - http://www.ncbi.nlm.nih.gov/pubmed/36251360 ID - info:doi/10.2196/37938 ER - TY - JOUR AU - Yang, Dai-Jie AU - Lu, Meng-Yao AU - Chen, Chi-Wen AU - Liu, Pei-Ching AU - Hou, I-Ching PY - 2022/8/22 TI - Development of a Therapeutic Video Game With the MDA Framework to Decrease Anxiety in Preschool-Aged Children With Acute Lymphoblastic Leukemia: Mixed Methods Approach JO - JMIR Serious Games SP - e37079 VL - 10 IS - 3 KW - acute lymphoblastic leukemia KW - therapeutic video games KW - childhood cancer KW - preschoolers KW - anxiety N2 - Background: Preschool-aged children with acute lymphoblastic leukemia (ALL) receive long-term treatment according to the Taiwan Pediatric Oncology Group (TPOG)?ALL 2013 protocol. Severe anxiety and noncompliance ahead of frequent invasive therapies leads to an increase in health care costs. Previous studies have shown that therapeutic video games (TVGs) can decrease the anxiety experienced by children who are ill. To our knowledge, no existing TVG has been designed specifically for preschool-aged children with ALL in Taiwan. Objective: The purpose of this study was to develop a TVG using the popular Mechanics, Dynamics, and Aesthetics (MDA) framework for game design and to investigate the effect of this TVG on the reduction of therapy-related anxiety among preschool-aged children with ALL. Methods: This study used a mixed methods approach over three phases: (1) develop a TVG using the MDA framework, (2) test the reliability of the TVG among three certified children?s art therapists, and (3) evaluate the reduction of therapy-related anxiety among participants after using the TVG for 6 weeks, using a two-group, stratified randomized controlled trial at a medical center in northern Taiwan. Eligible preschool-aged children with ALL were randomly assigned 1:1 into an experimental group or a control group. The two groups of subjects received the same usual care, and only the experimental group had access to and used the TVG. The children?s anxiety responses were reported by their family caregivers using the face rating scale (FRS). Descriptive analyses, the Fisher exact test, the Pearson chi-square test, and the Mann-Whitney U test were used to statistically analyze the variables. Results: Six mechanics rules supported the dynamics of the TVG using four main features?character, nursery, tasks, and market?in order to complete all of the therapy-related anxiety reduction scenarios and to achieve eight aesthetics goals. The results of reliability test showed that participants found the TVG to be useful and trustworthy for preschool-aged children with ALL (Cronbach ?=.98). A total of 15 participants were enrolled and randomly allocated to the experimental group (n=7) or the control group (n=8). The average number of TVG log-ins was 37.9 (SD 15.30, range 14-62) in the experimental group. The demographic data showed homogeneity across the two groups regarding age (3 to 5 years), sex (male), risk classification (standard risk), and treatment status (continuation therapy). The mean FRS score was 6.16 (SD 3.31) for the experimental group as compared to 7.45 (SD 2.71) for the control group (P=.04), which represented a significant difference between the groups at the 6-week follow-up. Conclusions: This research provides evidence that using a TVG can decrease anxiety in preschool-aged children with ALL in Taiwan. The TVG could be used to support clinical professionals before they perform invasive therapies. However, it is recommended to increase the statistical power for inference. Trial Registration: ClinicalTrials.gov NCT04199637; https://www.clinicaltrials.gov/ct2/show/NCT04199637 UR - https://games.jmir.org/2022/3/e37079 UR - http://dx.doi.org/10.2196/37079 UR - http://www.ncbi.nlm.nih.gov/pubmed/35994340 ID - info:doi/10.2196/37079 ER - TY - JOUR AU - Almeqbaali, Mariam AU - Ouhbi, Sofia AU - Serhani, Adel Mohamed AU - Amiri, Leena AU - Jan, K. Reem AU - Zaki, Nazar AU - Sharaf, Ayman AU - Al Helali, Abdulla AU - Almheiri, Eisa PY - 2022/8/2 TI - A Biofeedback-Based Mobile App With Serious Games for Young Adults With Anxiety in the United Arab Emirates: Development and Usability Study JO - JMIR Serious Games SP - e36936 VL - 10 IS - 3 KW - connected mental health KW - mental health KW - anxiety KW - digital game KW - biofeedback KW - app KW - serious game KW - gaming KW - gamification KW - young adult KW - user-centered design KW - stress KW - stress relief KW - user-centred design KW - youth KW - user feedback KW - user experience KW - usability KW - user need KW - development KW - mHealth KW - mobile health N2 - Background: Following the outbreak of COVID-19, several studies have reported that young adults encountered a rise in anxiety symptoms, which could negatively affect their quality of life. Promising evidence suggests that mobile apps with biofeedback, serious games, breathing exercises, and positive messaging, among other features, are useful for anxiety self-management and treatment. Objective: This study aimed to develop and evaluate the usability of a biofeedback-based app with serious games for young adults with anxiety in the United Arab Emirates (UAE). Methods: This study consists of two phases: Phase I describes the design and development of the app, while Phase II presents the results of a usability evaluation by experts. To elicit the app?s requirements during Phase I, we conducted (1) a survey to investigate preferences of young adults in the UAE for mobile games for stress relief; (2) an analysis of serious games for anxiety; and (3) interviews with mental health professionals and young adults in the UAE. In Phase II, five experts tested the usability of the developed app using a set of Nielsen?s usability heuristics. Results: A fully functional biofeedback-based app with serious games was co-designed with mental health professionals. The app included 4 games (ie, a biofeedback game, card game, arcade game, and memory game), 2 relaxation techniques (ie, a breathing exercise and yoga videos), and 2 additional features (ie, positive messaging and a mood tracking calendar). The results of Phase II showed that the developed app is efficient, simple, and easy to use. Overall, the app design scored an average of 4 out of 5. Conclusions: The elicitation techniques used in Phase I resulted in the development of an easy-to-use app for the self-management of anxiety. Further research is required to determine the app?s usability and effectiveness in the target population. UR - https://games.jmir.org/2022/3/e36936 UR - http://dx.doi.org/10.2196/36936 UR - http://www.ncbi.nlm.nih.gov/pubmed/35916692 ID - info:doi/10.2196/36936 ER - TY - JOUR AU - Sújar, Aarón AU - Martín-Moratinos, Marina AU - Rodrigo-Yanguas, María AU - Bella-Fernández, Marcos AU - González-Tardón, Carlos AU - Delgado-Gómez, David AU - Blasco-Fontecilla, Hilario PY - 2022/8/1 TI - Developing Serious Video Games to Treat Attention Deficit Hyperactivity Disorder: Tutorial Guide JO - JMIR Serious Games SP - e33884 VL - 10 IS - 3 KW - serious video games KW - ADHD KW - treatment KW - video games KW - cognitive KW - cognitive disorder KW - games UR - https://games.jmir.org/2022/3/e33884 UR - http://dx.doi.org/10.2196/33884 UR - http://www.ncbi.nlm.nih.gov/pubmed/35916694 ID - info:doi/10.2196/33884 ER - TY - JOUR AU - Wehbe, R. Rina AU - Whaley, Colin AU - Eskandari, Yasaman AU - Suarez, Ally AU - Nacke, E. Lennart AU - Hammer, Jessica AU - Lank, Edward PY - 2022/5/19 TI - Designing a Serious Game (Above Water) for Stigma Reduction Surrounding Mental Health: Semistructured Interview Study With Expert Participants JO - JMIR Serious Games SP - e21376 VL - 10 IS - 2 KW - human?computer interaction KW - games for change KW - games for mental health KW - sensitive topics KW - game design KW - empirical analysis KW - expert participants N2 - 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. UR - https://games.jmir.org/2022/2/e21376 UR - http://dx.doi.org/10.2196/21376 UR - http://www.ncbi.nlm.nih.gov/pubmed/35588056 ID - info:doi/10.2196/21376 ER - TY - JOUR AU - Kleschnitzki, Marina Jana AU - Grossmann, Inga AU - Beyer, Reinhard AU - Beyer, Luzi PY - 2022/5/10 TI - Modification in the Motor Skills of Seniors in Care Homes Using Serious Games and the Impact of COVID-19: Field Study JO - JMIR Serious Games SP - e36768 VL - 10 IS - 2 KW - serious games KW - motor skills KW - motor KW - long-term care KW - exercise KW - movement KW - coronavirus effects KW - eHealth KW - seniors KW - older adult KW - elder KW - senior population KW - aged KW - care home KW - intervention effects analysis KW - COVID-19 KW - pandemic KW - digital game KW - digital health KW - physical activity N2 - Background: The pandemic has highlighted the importance of low-threshold opportunities for exercise and physical activity. At the beginning of 2020, the COVID-19 pandemic led to many restrictions, which affected seniors in care facilities in the form of severe isolation. The isolation led, among other things, to a lack of exercise, which has led to a multitude of negative effects for this target group. Serious games can potentially help by being used anywhere at any time to strengthen skills with few resources. Objective: The aim of this study is to evaluate the effectiveness of a serious game to strengthen motor skills (study 1) and the influence of pandemic restrictions (study 2) on seniors in care facilities. Methods: The data on motor skills (measured by the Tinetti test) originated from an intervention study with repeated measurements that was interrupted by the pandemic conditions. Data were collected 4 times every 3 months with an intervention group (IG, training 3 times for 1 hour per week) and a control group (CG, no intervention). There were 2 substudies. The first considered the first 6 months until the pandemic restrictions, while the second considered the influence of the restrictions on motor skills. Results: The sample size was 70. The IG comprised 31 (44%) participants, with 22 (71%) female and 9 (29%) male seniors with an average age of 85 years. The CG comprised 39 (56%) participants, with 31 (79%) female and 8 (21%) male seniors with an average age of 87 years. In study 1, mixed-design ANOVA showed no significant interaction between measurement times and group membership for the first measurements (F2.136=1.414, P<.25, partial ?2=.044), but there was a significant difference between the CG (mean 16.23, SD 1.1) and the IG (mean 19.81, SD 1.2) at the third time of measurement (P=.02). In study 2 the mixed-design ANOVA (used to investigate motor skills before and after the pandemic conditions between the 2 groups) couldn?t reveal any significant interaction between measurement times and group membership: F1.67=2.997, P<.09, partial ?2=.043. However, there was a significant main effect of the time of measurement: F1.67=5.44, P<.02, partial ?˛=.075. Conclusions: During the first 6 months, the IG showed increased motor skills, whereas the motor skills of the CG slightly deteriorated and showed a statistically significant difference after 6 months. The pandemic restrictions leveled the difference and showed a significant negative effect on motor skills over 3 months. As our results show, digital games have the potential to break down access barriers and promote necessary maintenance for important skills. The pandemic has highlighted the importance of low-threshold opportunities for exercise and physical activity. This potentially great benefit for the challenges of tomorrow shows the relevance of the topic and demonstrates the urgent need for action and research. Trial Registration: Deutsches Register klinischer Studien DRKS00016633; https://tinyurl.com/yckmj4px UR - https://games.jmir.org/2022/2/e36768 UR - http://dx.doi.org/10.2196/36768 UR - http://www.ncbi.nlm.nih.gov/pubmed/35536610 ID - info:doi/10.2196/36768 ER - TY - JOUR AU - Nřrlev, Jannie AU - Derosche, Christina AU - Sondrup, Katrine AU - Hejlesen, Ole AU - Hangaard, Stine PY - 2022/3/29 TI - Using Distance Communication for the User-Centered Development of a Smartphone-Based Serious Game for Children With Type 1 Diabetes: Participatory Design Approach JO - JMIR Serious Games SP - e33955 VL - 10 IS - 1 KW - type 1 diabetes KW - children KW - serious game KW - distance communication KW - user-centered approach KW - evaluation KW - playtest KW - mobile phone N2 - Background: The complications of type 1 diabetes (T1D) can be delayed or prevented in children with T1D who receive proper self-management education. Smartphone-based serious games are increasingly being used as an effective tool for teaching self-management. When developing a serious game, it is important that the development process be user-centered. Traditionally, different face-to-face methods have been used when children participate in the development process. However, face-to-face data collection is not always feasible. In such situations, distance communication can be used when developing a serious game. Objective: The objective of this study is to develop a user-centered smartphone-based serious game that teaches self-management focused on carbohydrate intake in children aged 8-14 years with T1D using distance communication in both the development and evaluation of the game. Methods: The development and evaluation of a smartphone-based serious game prototype was inspired by the Lean principles, and a user-centered approach was applied. The development process included 1 expert interview and design workshops with children with T1D. On the basis of the interview and design workshop results, a serious game prototype was developed using Microsoft PowerPoint. The evaluation of the serious game prototype included an interview with a dietitian and a playtest with children with T1D. All data were collected using distance communication. Results: A user-centered smartphone-based serious game prototype was developed and evaluated. The expert interview with the dietitian formed the basis for the learning outcomes in the game. Four children and their parents contributed to the preferences, needs, requirements, and ideas for selected parts of the game design. The dietitian evaluated the prototype positively and validated its content and accuracy. The serious game prototype was well-received by the children and their parents during the playtest. The serious game prototype was perceived as a useful and engaging way to learn. However, the difficulty level was not appropriate, and the information was too basic for participants who had been diagnosed over a year ago. The use of digital communication platforms did not cause any problems. Conclusions: The smartphone-based serious game prototype has the potential to be a useful and attractive tool for teaching disease self-management. The use of distance communication proved to be a useful approach in the development of a serious game. UR - https://games.jmir.org/2022/1/e33955 UR - http://dx.doi.org/10.2196/33955 UR - http://www.ncbi.nlm.nih.gov/pubmed/35348466 ID - info:doi/10.2196/33955 ER - TY - JOUR AU - Pouls, PH Bart AU - Bekker, L. Charlotte AU - van Dulmen, Sandra AU - Vriezekolk, E. Johanna AU - van den Bemt, JF Bart PY - 2022/2/18 TI - A Serious Puzzle Game to Enhance Adherence to Antirheumatic Drugs in Patients With Rheumatoid Arthritis: Systematic Development Using Intervention Mapping JO - JMIR Serious Games SP - e31570 VL - 10 IS - 1 KW - medication adherence KW - serious game KW - eHealth KW - rheumatoid arthritis KW - intervention mapping KW - intervention development N2 - Background: Patients? implicit attitudes toward medication need and concerns may influence their adherence. Targeting these implicit attitudes by combining game-entertainment with medication-related triggers might improve medication adherence in patients with rheumatoid arthritis (RA). Objective: The aim of this study was to describe the systematic development of a serious game to enhance adherence to antirheumatic drugs by using intervention mapping. Methods: A serious game was developed using the intervention mapping framework guided by a multidisciplinary expert group, which proceeded along 6 steps: (1) exploring the problem by assessing the relationship between medication adherence and implicit attitudes, (2) defining change objectives, (3) selecting evidence-based behavior change techniques that focused on adjusting implicit attitudes, (4) designing the intervention, (5) guaranteeing implementation by focusing on intrinsic motivation, and (6) planning a scientific evaluation. Results: Based on the problem assessment and guided by the Dual-Attitude Model, implicit negative and illness-related attitudes of patients with RA were defined as the main target for the intervention. Consequently, the change objective was ?after the intervention, participants have a more positive attitude toward antirheumatic drugs.? Attention bias modification, evaluative conditioning, and goal priming were the techniques chosen to implicitly target medication needs. These techniques were redesigned into medication-related triggers and built in the serious puzzle game. Thirty-seven patients with RA tested the game at several stages. Intrinsic motivation was led by the self-determination theory and addressed the 3 needs, that is, competence, autonomy, and relatedness. The intervention will be evaluated in a randomized clinical trial that assesses the effect of playing the serious game on antirheumatic drug adherence. Conclusions: We systematically developed a serious game app to enhance adherence to antirheumatic drugs among patients with RA by using the intervention mapping framework. This paper could serve as a guideline for other health care providers when developing similar interventions. UR - https://games.jmir.org/2022/1/e31570 UR - http://dx.doi.org/10.2196/31570 UR - http://www.ncbi.nlm.nih.gov/pubmed/35179510 ID - info:doi/10.2196/31570 ER - TY - JOUR AU - Ade-Ibijola, Abejide AU - Young, Keagan AU - Sivparsad, Nashik AU - Seforo, Mpho AU - Ally, Suhail AU - Olowolafe, Adebola AU - Frahm-Arp, Maria PY - 2022/2/16 TI - Teaching Students About Plagiarism Using a Serious Game (Plagi-Warfare): Design and Evaluation Study JO - JMIR Serious Games SP - e33459 VL - 10 IS - 1 KW - serious games KW - educational games KW - plagiarism KW - library games KW - game mechanics KW - education KW - teaching N2 - Background: Educational games have been proven to support the teaching of various concepts across disciplines. Plagiarism is a major problem among undergraduate and postgraduate students at universities. Objective: In this paper, we propose a game called Plagi-Warfare that attempts to teach students about plagiarism. Methods: To do this at a level that is beyond quizzes, we proposed a game storyline and mechanics that allow the player (or student) to play as a mafia member or a detective. This either demonstrated their knowledge by plagiarizing within the game as a mafia member or catching plagiarists within the game as a detective. The game plays out in a 3D environment representing the major libraries of the University of Johannesburg, South Africa. In total, 30 students were selected to evaluate the game. Results: Evaluation of the game mechanics and storyline showed that the student gamers enjoyed the game and learned about plagiarism. Conclusions: In this paper, we presented a new educational game that teaches students about plagiarism by using a new crime story and an immersive 3D gaming environment representing the libraries of the University of Johannesburg. UR - https://games.jmir.org/2022/1/e33459 UR - http://dx.doi.org/10.2196/33459 UR - http://www.ncbi.nlm.nih.gov/pubmed/35171103 ID - info:doi/10.2196/33459 ER - TY - JOUR AU - Liu, Yunxin AU - Stamos, Angelos AU - Dewitte, Siegfried AU - van Berlo, C. Zeph M. AU - van der Laan, N. Laura PY - 2022/2/3 TI - Development and Evaluation of a Virtual Reality Puzzle Game to Decrease Food Intake: Randomized Controlled Trial JO - JMIR Serious Games SP - e31747 VL - 10 IS - 1 KW - virtual reality KW - pre-exposure KW - self-control KW - hedonic consumption KW - food cravings N2 - Background: Virtual reality (VR) has gained popularity in daily life, and VR food cues seem to elicit food cravings, similar to real food cues. However, little is known about the impact of VR food cues on actual food intake. Objective: In real life (RL), exposure to food cues in a situation in which the desire to eat food interferes with the completion of a food-related task reduces the subsequent food intake (ie, the pre-exposure effect). In this study, we examine, on the one hand, whether the pre-exposure effect could be replicated in RL and, on the other hand, whether this effect could be extended to VR contexts. Methods: The study used a 2 (stimulus type: food vs nonfood) × 2 (mode: VR vs RL) between-subject design (n=175). Participants were randomly assigned to 1 of the 4 conditions. Results: We found the main effect of mode on food intake, with a higher food intake after both VR conditions than after RL conditions (P=.02). In addition, among female participants, we found that exposure to both food cues (ie, VR and RL) resulted in lower food intake than exposure to both nonfood cues (P=.05). In contrast, this effect was not observed among male participants (P=.34). Additionally, VR and RL cues generated similar emotional and behavioral responses (eg, arousal and game difficulty). Conclusions: We were unable to replicate the exposure effect in our complete sample. Subgroup analyses, however, showed that for women, exposure to food cues (either in VR or in RL) reduces food intake, indicating that a VR pre-exposure procedure may effectively be applied exclusively for women. Trial Registration: ClinicalTrials.gov NCT05169996; https://clinicaltrials.gov/ct2/show/NCT05169996 UR - https://games.jmir.org/2022/1/e31747 UR - http://dx.doi.org/10.2196/31747 UR - http://www.ncbi.nlm.nih.gov/pubmed/35113028 ID - info:doi/10.2196/31747 ER - TY - JOUR AU - Abraham, Olufunmilola AU - Szela, Lisa AU - Khan, Mahnoor AU - Geddam, Amrita PY - 2022/1/24 TI - Exploring Middle School Students? Perspectives on Using Serious Games for Cancer Prevention Education: Focus Group Study JO - JMIR Serious Games SP - e31172 VL - 10 IS - 1 KW - adolescents KW - adolescent education KW - adolescent health KW - older children KW - middle school students KW - cancer awareness KW - cancer education KW - cancer prevention KW - health education KW - serious games N2 - Background: Cancer in the United States is a leading cause of mortality. Educating adolescents about cancer risks can improve awareness and introduce healthy lifestyle habits. Public health efforts have made significant progress in easing the burden of cancer through the promotion of early screening and healthy lifestyle advocacy. However, there are limited interventions that educate the adolescent population about cancer prevention. Previous studies have demonstrated the effectiveness of serious games (SGs) to teach adolescents about healthy lifestyle choices, but few research efforts have examined the utility of using SGs to educate youth specifically on cancer prevention. Objective: This study aimed to investigate middle school students? preferences for the use of SGs for cancer prevention education. The study also characterized the students? perceptions of desired game design features for a cancer prevention SG. Methods: Focus groups were held to allow adolescents to review a game playbook and discuss gaming behaviors and preferences for an SG for cancer education. The game playbook was developed based on ?Cancer, Clear & Simple,? a curriculum intended to educate individuals about cancer, prevention, self-care, screening, and detection. In the game, the player learns that they have cancer and is given the opportunity to go back in time to reduce their cancer risk. A focus group discussion guide was developed and consisted of questions about aspects of the playbook and the participants? gaming experience. The participants were eligible if they were 12 to 14 years old, could speak and understand English, and had parents who could read English or Spanish. Each focus group consisted of 5 to 10 persons. The focus groups were audio recorded and professionally transcribed; they were then analyzed content-wise and thematically by 2 study team members. Intercoder reliability (kappa coefficient) among the coders was reported as 0.97. The prevalent codes were identified and categorized into themes and subthemes. Results: A total of 18 focus groups were held with 139 participants from a Wisconsin middle school. Most participants had at least ?some? gaming experience. Three major themes were identified, which were educational video games, game content, and purpose of game. The participants preferred customizable characters and realistic story lines that allowed players to make choices that affect the characters? outcomes. Middle school students also preferred SGs over other educational methods such as lectures, books, videos, and websites. The participants desired SGs to be available across multiple platforms and suggested the use of SGs for cancer education in their school. Conclusions: Older children and adolescents consider SGs to be an entertaining tool to learn about cancer prevention and risk factors. Their design preferences should be considered to create a cancer education SG that is acceptable and engaging for youth. UR - https://games.jmir.org/2022/1/e31172 UR - http://dx.doi.org/10.2196/31172 UR - http://www.ncbi.nlm.nih.gov/pubmed/34643533 ID - info:doi/10.2196/31172 ER - TY - JOUR AU - Jaccard, Dominique AU - Suppan, Laurent AU - Bielser, Félicia PY - 2021/11/24 TI - Contribution of the co.LAB Framework to the Collaborative Design of Serious Games: Mixed Methods Validation Study JO - JMIR Serious Games SP - e33144 VL - 9 IS - 4 KW - serious game KW - educational game KW - education KW - simulation game KW - gaming KW - design KW - framework KW - methodology KW - mixed method KW - validation N2 - 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. UR - https://games.jmir.org/2021/4/e33144 UR - http://dx.doi.org/10.2196/33144 UR - http://www.ncbi.nlm.nih.gov/pubmed/34822336 ID - info:doi/10.2196/33144 ER - TY - JOUR AU - Ambros-Antemate, Fernando Jorge AU - Beristain-Colorado, Pilar María Del AU - Vargas-Trevińo, Marciano AU - Gutiérrez-Gutiérrez, Jaime AU - Hernández-Cruz, Antonio Pedro AU - Gallegos-Velasco, Belem Itandehui AU - Moreno-Rodríguez, Adriana PY - 2021/11/11 TI - Software Engineering Frameworks Used for Serious Games Development in Physical Rehabilitation: Systematic Review JO - JMIR Serious Games SP - e25831 VL - 9 IS - 4 KW - serious game KW - physical rehabilitation KW - framework KW - methodology N2 - 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. UR - https://games.jmir.org/2021/4/e25831 UR - http://dx.doi.org/10.2196/25831 UR - http://www.ncbi.nlm.nih.gov/pubmed/34762052 ID - info:doi/10.2196/25831 ER - TY - JOUR AU - Kamnardsiri, Teerawat AU - Phirom, Kochaphan AU - Boripuntakul, Sirinun AU - Sungkarat, Somporn PY - 2021/10/27 TI - An Interactive Physical-Cognitive Game-Based Training System Using Kinect for Older Adults: Development and Usability Study JO - JMIR Serious Games SP - e27848 VL - 9 IS - 4 KW - digital game KW - interactive game-based training KW - physical-cognitive training KW - exergaming KW - Kinect sensors KW - older adults KW - falls KW - PACES KW - user-centered design KW - game-based exercise N2 - Background: Declines in physical and cognitive functions are recognized as important risk factors for falls in older adults. Promising evidence suggests that interactive game-based systems that allow simultaneous physical and cognitive exercise are a potential approach to enhance exercise adherence and reduce fall risk in older adults. However, a limited number of studies have reported the development of a combined physical-cognitive game-based training system for fall risk reduction in older adults. Objective: The aim of this study is to develop and evaluate the usability of an interactive physical-cognitive game-based training system (game-based exercise) for older adults. Methods: In the development phase (Part I), a game-based exercise prototype was created by integrating knowledge and a literature review as well as brainstorming with experts on effective fall prevention exercise for older adults. The output was a game-based exercise prototype that covers crucial physical and cognitive components related to falls. In the usability testing (Part II), 5 games (ie, Fruits Hunter, Where Am I?, Whack a Mole, Sky Falls, and Crossing Poison River) with three difficulty levels (ie, beginner, intermediate, and advanced levels) were tested in 5 older adults (mean age 70.40 years, SD 5.41 years). After completing the games, participants rated their enjoyment level while engaging with the games using the Physical Activity Enjoyment Scale (PACES) and commented on the games. Descriptive statistics were used to describe the participants? characteristics and PACES scores. Results: The results showed that the average PACES score was 123 out of 126 points overall and between 6.66 and 7.00 for each item, indicating a high level of enjoyment. Positive feedback, such as praise for the well-designed interactions and user-friendly interfaces, was also provided. Conclusions: These findings suggest that it is promising to implement an interactive, physical-cognitive game-based exercise in older adults. The effectiveness of a game-based exercise program for fall risk reduction has yet to be determined. UR - https://games.jmir.org/2021/4/e27848 UR - http://dx.doi.org/10.2196/27848 UR - http://www.ncbi.nlm.nih.gov/pubmed/34704953 ID - info:doi/10.2196/27848 ER - TY - JOUR AU - Abensur Vuillaume, Laure AU - Laudren, Garry AU - Bosio, Alexandre AU - Thévenot, Pauline AU - Pelaccia, Thierry AU - Chauvin, Anthony PY - 2021/8/31 TI - A Didactic Escape Game for Emergency Medicine Aimed at Learning to Work as a Team and Making Diagnoses: Methodology for Game Development JO - JMIR Serious Games SP - e27291 VL - 9 IS - 3 KW - training techniques KW - educational technique KW - game theories KW - emergency medicine KW - games KW - education KW - escape game KW - simulation-based training KW - pedagogical KW - serious games KW - emergency medicine training N2 - Background: In the health care environment, teamwork is paramount, especially when referring to patient safety. We are interested in recent and innovative solutions such as escape games, which is a type of adventure game that may be highly useful as an educational tool, potentially combining good communication skills with successful gamification. They involve teams of 5 to 10 individuals who are ?locked? in the same room and must collaborate to solve puzzles while under pressure from a timer. Objective: The purpose of this paper was to describe the steps involved in creating and implementing an educational escape game. This tool can then be put into service or further developed by trainers who wish to use it for learning interprofessional collaboration. Therefore, we started with an experience of creating an educational escape game for emergency medicine teams. Methods: We chose to develop an educational escape game by using 6 successive steps. First, we built a team. Second, we chose the pedagogical objectives. Third, we gamified (switched from objectives to scenario). Next, we found the human and material resources needed. Thereafter, we designed briefing and debriefing. Lastly, we tested the game. Results: By following these 6 steps, we created the first ambulant educational escape game that teaches people, or nurses, doctors, and paramedics, working in emergency medicine to work as a team. Conclusions: From a pedagogic point of view, this game may be a good tool for helping people in multidisciplinary fields (medical and paramedical teams) to learn how to work collaboratively and to communicate as a group. Above all, it seems to be an innovative tool that complements medical simulation?based learning and thus consolidates traditional education. UR - https://games.jmir.org/2021/3/e27291 UR - http://dx.doi.org/10.2196/27291 UR - http://www.ncbi.nlm.nih.gov/pubmed/34463628 ID - info:doi/10.2196/27291 ER - TY - JOUR AU - Wiley, Katelyn AU - Robinson, Raquel AU - Mandryk, L. Regan PY - 2021/8/9 TI - The Making and Evaluation of Digital Games Used for the Assessment of Attention: Systematic Review JO - JMIR Serious Games SP - e26449 VL - 9 IS - 3 KW - cognitive assessment KW - attention KW - serious games KW - gamification KW - systematic review KW - mobile phone N2 - Background: Serious games are now widely used in many contexts, including psychological research and clinical use. One area of growing interest is that of cognitive assessment, which seeks to measure different cognitive functions such as memory, attention, and perception. Measuring these functions at both the population and individual levels can inform research and indicate health issues. Attention is an important function to assess, as an accurate measure of attention can help diagnose many common disorders, such as attention-deficit/hyperactivity disorder and dementia. However, using games to assess attention poses unique problems, as games inherently manipulate attention through elements such as sound effects, graphics, and rewards, and research on adding game elements to assessments (ie, gamification) has shown mixed results. The process for developing cognitive tasks is robust, with high psychometric standards that must be met before these tasks are used for assessment. Although games offer more diverse approaches for assessment, there is no standard for how they should be developed or evaluated. Objective: To better understand the field and provide guidance to interdisciplinary researchers, we aim to answer the question: How are digital games used for the cognitive assessment of attention made and measured? Methods: We searched several databases for papers that described a digital game used to assess attention that could be deployed remotely without specialized hardware. We used Rayyan, a systematic review software, to screen the records before conducting a systematic review. Results: The initial database search returned 49,365 papers. Our screening process resulted in a total of 74 papers that used a digital game to measure cognitive functions related to attention. Across the studies in our review, we found three approaches to making assessment games: gamifying cognitive tasks, creating custom games based on theories of cognition, and exploring potential assessment properties of commercial games. With regard to measuring the assessment properties of these games (eg, how accurately they assess attention), we found three approaches: comparison to a traditional cognitive task, comparison to a clinical diagnosis, and comparison to knowledge of cognition; however, most studies in our review did not evaluate the game?s properties (eg, if participants enjoyed the game). Conclusions: Our review provides an overview of how games used for the assessment of attention are developed and evaluated. We further identified three barriers to advancing the field: reliance on assumptions, lack of evaluation, and lack of integration and standardization. We then recommend the best practices to address these barriers. Our review can act as a resource to help guide the field toward more standardized approaches and rigorous evaluation required for the widespread adoption of assessment games. UR - https://games.jmir.org/2021/3/e26449 UR - http://dx.doi.org/10.2196/26449 UR - http://www.ncbi.nlm.nih.gov/pubmed/34383674 ID - info:doi/10.2196/26449 ER - TY - JOUR AU - Endendijk, Johanna Joyce AU - Tichelaar, Henny AU - Deen, Menno AU - Dekovi?, Maja PY - 2021/8/3 TI - A Therapeutic Game for Sexually Abused Children and Adolescents (Vil Du?!): Exploratory Mixed Methods Evaluation JO - JMIR Serious Games SP - e26062 VL - 9 IS - 3 KW - child sexual abuse KW - psychotherapy KW - serious games KW - evaluation KW - working elements KW - acceptability N2 - Background: Talking about experiences of sexual abuse in therapy is difficult for children and adolescents. Possible reasons for this difficulty are a lack of vocabulary to describe the situation or feelings of shame, fear, and self-blame associated with sexual abuse. The serious game Vil Du?! was developed to help children open up about their sexual abuse experiences. Vil Du?! is a nonverbal communication game that resembles a dress-up game in which children can show the therapist what happened to them. Objective: This exploratory evaluation study examines which working elements of the game could be identified in therapy with victims of sexual abuse (aim 1). In addition, this study examines how therapists evaluate the acceptability of the game (aim 2). Methods: The therapists completed 23 web-based surveys on the use of Vil Du?! In addition, semistructured interviews were conducted with 10 therapists. The data were analyzed in NVivo following previously reported stepwise guidelines. Results: Regarding aim 1, therapists mentioned various working elements of Vil Du?!; for instance, Vil Du?! puts the child in control of the situation. In addition, Vil Du?! reduces barriers to disclosure because there is no need to talk or have eye contact with the therapist. Regarding aim 2, Vil Du?! was generally evaluated more positively than negatively by the therapists. For instance, therapists indicated that using Vil Du?! is time efficient and might make the treatment process less confronting and difficult for the client. According to therapists, most clients indeed experienced less tension and more positive (or neutral) emotions than negative emotions when using Vil Du?! Conclusions: The most important working elements of Vil Du?!, according to therapists, are that it enables children to regain control over their sexual abuse experiences and reduces barriers to disclosing sexual abuse experiences. The more positive evaluation of Vil Du?! indicates the acceptability of the game for therapists as well as their clients. UR - https://games.jmir.org/2021/3/e26062 UR - http://dx.doi.org/10.2196/26062 UR - http://www.ncbi.nlm.nih.gov/pubmed/34342592 ID - info:doi/10.2196/26062 ER - TY - JOUR AU - Jaccard, Dominique AU - Suppan, Laurent AU - Sanchez, Eric AU - Huguenin, Audrey AU - Laurent, Maxence PY - 2021/7/2 TI - The co.LAB Generic Framework for Collaborative Design of Serious Games: Development Study JO - JMIR Serious Games SP - e28674 VL - 9 IS - 3 KW - serious game KW - educational game KW - simulation game KW - design KW - design framework KW - methodology KW - collaborative design KW - collaborative web platform N2 - 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. UR - https://games.jmir.org/2021/3/e28674 UR - http://dx.doi.org/10.2196/28674 UR - http://www.ncbi.nlm.nih.gov/pubmed/34255655 ID - info:doi/10.2196/28674 ER - TY - JOUR AU - Beristain-Colorado, Pilar María Del AU - Ambros-Antemate, Fernando Jorge AU - Vargas-Trevińo, Marciano AU - Gutiérrez-Gutiérrez, Jaime AU - Moreno-Rodriguez, Adriana AU - Hernández-Cruz, Antonio Pedro AU - Gallegos-Velasco, Belem Itandehui AU - Torres-Rosas, Rafael PY - 2021/6/24 TI - Standardizing the Development of Serious Games for Physical Rehabilitation: Conceptual Framework Proposal JO - JMIR Serious Games SP - e25854 VL - 9 IS - 2 KW - serious game KW - physical rehabilitation KW - framework KW - software engineering KW - gamification N2 - 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. UR - https://games.jmir.org/2021/2/e25854/ UR - http://dx.doi.org/10.2196/25854 UR - http://www.ncbi.nlm.nih.gov/pubmed/34185003 ID - info:doi/10.2196/25854 ER - TY - JOUR AU - Kim, Heon Ho AU - An, Il Jae AU - Park, Rang Yu PY - 2021/6/4 TI - A Prediction Model for Detecting Developmental Disabilities in Preschool-Age Children Through Digital Biomarker-Driven Deep Learning in Serious Games: Development Study JO - JMIR Serious Games SP - e23130 VL - 9 IS - 2 KW - developmental delay KW - diagnosis prediction KW - deep learning KW - serious games KW - digital health KW - digital phenotyping KW - digital biomarkers N2 - 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. UR - https://games.jmir.org/2021/2/e23130 UR - http://dx.doi.org/10.2196/23130 UR - http://www.ncbi.nlm.nih.gov/pubmed/34085944 ID - info:doi/10.2196/23130 ER - TY - JOUR AU - Yildirim, Oguzcan AU - Surer, Elif PY - 2021/5/31 TI - Developing Adaptive Serious Games for Children With Specific Learning Difficulties: A Two-phase Usability and Technology Acceptance Study JO - JMIR Serious Games SP - e25997 VL - 9 IS - 2 KW - serious games KW - adaptive games KW - specific learning difficulty KW - usability KW - system usability scale KW - technology acceptance model KW - training KW - development KW - adaptation KW - gaming KW - learning disability KW - children KW - education KW - teacher N2 - Background: Specific learning difficulties (SpLD) include several disorders such as dyslexia, dyscalculia, and dysgraphia, and the children with these SpLD receive special education. However, the studies and the educational material so far focus mainly on one specific disorder. Objective: This study?s primary goal is to develop comprehensive training material for different types of SpLD, with five serious games addressing different aspects of the SpLD. The second focus is measuring the impact of adaptive difficulty level adjustment in the children?s and their educators? usability and technology acceptance perception. Receiving feedback from the children and their educators, and refining the games according to their suggestions have also been essential in this two-phase study. Methods: A total of 10 SpLD educators and 23 children with different types of SpLD tested the prototypes of the five serious games (ie, Word game, Memory game, Category game, Space game, and Math game), gave detailed feedback, answered the System Usability Scale and Technology Acceptance Model (TAM) questionnaires, and applied think-aloud protocols during game play. Results: The games? standard and adaptive versions were analyzed in terms of average playtime and the number of false answers. Detailed analyses of the interviews, with word clouds and player performances, were also provided. The TAM questionnaires? average and mean values and box plots of each data acquisition session for the children and the educators were also reported via System Usability Scale and TAM questionnaires. The TAM results of the educators had an average of 8.41 (SD 0.87) out of 10 in the first interview and an average of 8.71 (SD 0.64) out of 10 in the second interview. The children had an average of 9.07 (SD 0.56) out of 10 in the first interview. Conclusions: Both the educators and the children with SpLD enjoyed playing the games, gave positive feedback, and suggested new ways for improvement. The results showed that these games provide thorough training material for different types of SpLD with personalized and tailored difficulty systems. The final version of the proposed games will become a part of the special education centers? supplementary curriculum and training materials, making new enhancements and improvements possible in the future. UR - https://games.jmir.org/2021/2/e25997 UR - http://dx.doi.org/10.2196/25997 UR - http://www.ncbi.nlm.nih.gov/pubmed/34057415 ID - info:doi/10.2196/25997 ER - TY - JOUR AU - Lee, Seyeon AU - Oh, Hyunyoung AU - Shi, Chung-Kon AU - Doh, Yim Young PY - 2021/5/20 TI - Mobile Game Design Guide to Improve Gaming Experience for the Middle-Aged and Older Adult Population: User-Centered Design Approach JO - JMIR Serious Games SP - e24449 VL - 9 IS - 2 KW - mobile games KW - older adults KW - middle-aged adults KW - design guideline KW - gaming experience N2 - 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. UR - https://games.jmir.org/2021/2/e24449 UR - http://dx.doi.org/10.2196/24449 UR - http://www.ncbi.nlm.nih.gov/pubmed/34014175 ID - info:doi/10.2196/24449 ER - TY - JOUR AU - Park, Sungjin AU - Kim, Sangkyun PY - 2021/4/20 TI - Leaderboard Design Principles to Enhance Learning and Motivation in a Gamified Educational Environment: Development Study JO - JMIR Serious Games SP - e14746 VL - 9 IS - 2 KW - leaderboard design KW - gamification KW - learning motivation KW - affordance N2 - 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. UR - https://games.jmir.org/2021/2/e14746 UR - http://dx.doi.org/10.2196/14746 UR - http://www.ncbi.nlm.nih.gov/pubmed/33877049 ID - info:doi/10.2196/14746 ER - TY - JOUR AU - Terlouw, Gijs AU - Kuipers, Derek AU - van 't Veer, Job AU - Prins, T. Jelle AU - Pierie, N. Jean Pierre E. PY - 2021/3/23 TI - The Development of an Escape Room?Based Serious Game to Trigger Social Interaction and Communication Between High-Functioning Children With Autism and Their Peers: Iterative Design Approach JO - JMIR Serious Games SP - e19765 VL - 9 IS - 1 KW - serious game KW - autism KW - design research KW - boundary object N2 - Background: Children with autism spectrum disorder (ASD) have social deficits that affect social interactions, communication, and relationships with peers. Many existing interventions focus mainly on improving social skills in clinical settings. In addition to the direct instruction?based programs, activity-based programs could be of added value, especially to bridge the relational gap between children with ASD and their peers. Objective: The aim of this study is to describe an iterative design process for the development of an escape room?based serious game as a boundary object. The purpose of the serious game is to facilitate direct communication between high-functioning children with ASD and their peers, for the development of social skills on the one hand and strengthening relationships with peers through a fun and engaging activity on the other hand. Methods: This study is structured around the Design Research Framework to develop an escape room through an iterative-incremental process. With a pool of 37 children, including 23 children diagnosed with ASD (5 girls) and 14 children (7 girls) attending special primary education for other additional needs, 4 testing sessions around different prototypes were conducted. The beta prototype was subsequently reviewed by experts (n=12). During the design research process, we examined in small steps whether the developed prototypes are feasible and whether they have the potential to achieve the formulated goals of different stakeholders. Results: By testing various prototypes, several insights were found and used to improve the design. Insights were gained in finding a fitting and appealing theme for the children, composing the content, and addressing different constraints in applying the goals from the children?s and therapeutic perspectives. Eventually, a multiplayer virtual escape room, AScapeD, was developed. Three children can play the serious game in the same room on tablets. The first test shows that the game enacts equal cooperation and communication among the children. Conclusions: This paper presents an iterative design process for AScapeD. AScapeD enacts equal cooperation and communication in a playful way between children with ASD and their peers. The conceptual structure of an escape room contributes to the natural emergence of communication and cooperation. The iterative design process has been beneficial for finding a constructive game structure to address all formulated goals, and it contributed to the design of a serious game as a boundary object that mediates the various objectives of different stakeholders. We present 5 lessons learned from the design process. The developed prototype is feasible and has the potential to achieve the goals of the serious game. UR - https://games.jmir.org/2021/1/e19765 UR - http://dx.doi.org/10.2196/19765 UR - http://www.ncbi.nlm.nih.gov/pubmed/33755023 ID - info:doi/10.2196/19765 ER - TY - JOUR AU - Ishak, Affendi Shahrul AU - Din, Rosseni AU - Hasran, Azmah Umi PY - 2021/2/19 TI - Defining Digital Game-Based Learning for Science, Technology, Engineering, and Mathematics: A New Perspective on Design and Developmental Research JO - J Med Internet Res SP - e20537 VL - 23 IS - 2 KW - digital game-based learning KW - STEM digital game KW - game development model KW - game design KW - design and developmental research UR - http://www.jmir.org/2021/2/e20537/ UR - http://dx.doi.org/10.2196/20537 UR - http://www.ncbi.nlm.nih.gov/pubmed/33605885 ID - info:doi/10.2196/20537 ER - TY - JOUR AU - Fari?, Nu?a AU - Smith, Lee AU - Hon, Adrian AU - Potts, W. Henry W. AU - Newby, Katie AU - Steptoe, Andrew AU - Fisher, Abi PY - 2021/2/4 TI - A Virtual Reality Exergame to Engage Adolescents in Physical Activity: Mixed Methods Study Describing the Formative Intervention Development Process JO - J Med Internet Res SP - e18161 VL - 23 IS - 2 KW - adolescent KW - adult KW - exercise KW - leisure activities KW - obesity KW - sports KW - video games KW - mobile phone KW - virtual reality KW - motivation N2 - Background: Early adolescence (13-17 years) is a critical developmental stage for physical activity promotion. Virtual reality (VR) exergaming is a promising intervention strategy to engage adolescents in physical activity. Objective: The vEngage project aims to develop a physical activity intervention for adolescents using VR exergaming. Here, we describe the formative intervention development work and process of academic-industry collaboration. Methods: The formative development was guided by the Medical Research Council framework and included recruiting an adolescent user group to provide iterative feedback, a literature review, a quantitative survey of adolescents, qualitative interviews with adolescents and parents, inductive thematic analysis of public reviews of VR exergames, a quantitative survey and qualitative interviews with users of the augmented reality running app Zombies, Run!, and building and testing a prototype with our adolescent user group. Results: VR exergaming was appealing to adolescents and acceptable to parents. We identified behavior change techniques that users would engage with and features that should be incorporated into a VR exergame, including realistic body movements, accurate graphics, stepped levels of gameplay difficulty, new challenges, in-game rewards, multiplayer options, and the potential to link with real-world aspects such as physical activity trackers. We also identified some potential barriers to use, such as cost, perceived discomfort of VR headsets, and motion sickness concerns. A prototype game was developed and user-tested with generally positive feedback. Conclusions: This is the first attempt to develop a VR exergame designed to engage adolescents in physical activity that has been developed within a public health intervention development framework. Our formative work suggests that this is a very promising avenue. The benefit of the design process was the collaborative parallel work between academics and game designers and the involvement of the target population in the game (intervention) design from the outset. Developing the game within an intervention framework allowed us to consider factors, such as parental support, that would be important for future implementation. This study also serves as a call to action for potential collaborators who may wish to join this endeavor for future phases and an example of how academic-industry collaboration can be successful and beneficial. UR - http://www.jmir.org/2021/2/e18161/ UR - http://dx.doi.org/10.2196/18161 UR - http://www.ncbi.nlm.nih.gov/pubmed/33538697 ID - info:doi/10.2196/18161 ER - TY - JOUR AU - Shegog, Ross AU - Armistead, Laura AU - Markham, Christine AU - Dube, Sara AU - Song, Hsing-Yi AU - Chaudhary, Pooja AU - Spencer, Angela AU - Peskin, Melissa AU - Santa Maria, Diane AU - Wilkerson, Michael J. AU - Addy, Robert AU - Tortolero Emery, Susan AU - McLaughlin, Jeffery PY - 2021/1/27 TI - A Web-Based Game for Young Adolescents to Improve Parental Communication and Prevent Unintended Pregnancy and Sexually Transmitted Infections (The Secret of Seven Stones): Development and Feasibility Study JO - JMIR Serious Games SP - e23088 VL - 9 IS - 1 KW - serious game KW - intervention mapping KW - sexual health KW - adolescents KW - sexually transmitted infections KW - teenage pregnancy KW - parent, communication KW - intergenerational KW - mobile phone N2 - Background: Early adolescent unintended pregnancy and sexually transmitted infection prevention are significant public health challenges in the United States. Parental influence can help adolescents make responsible and informed sexual health decisions toward delayed sexual debut; yet parents often feel ill equipped to communicate about sex-related topics. Intergenerational games offer a potential strategy to provide life skills training to young adolescents (aged 11-14 years) while engaging them and their parents in communication about sexual health. Objective: This study aims to describe the development of a web-based online sexual health intergenerational adventure game, the Secret of Seven Stones (SSS), using an intervention mapping (IM) approach for developing theory- and evidence-based interventions. Methods: We followed the IM development steps to describe a theoretical and empirical model for young adolescent sexual health behavior, define target behaviors and change objectives, identify theory-based methods and practical applications to inform design and function, develop and test a prototype of 2 game levels to assess feasibility before developing the complete 18-level game, draft an implementation plan that includes a commercial dissemination strategy, and draft an evaluation plan including a study design for a randomized controlled trial efficacy trial of SSS. Results: SSS comprised an adventure game for young adolescent skills training delivered via a desktop computer, a text-based notification system to provide progress updates for parents and cues to initiate dialogue with their 11- to 14-year-old child, and a website for parent skills training and progress monitoring. Formative prototype testing demonstrated feasibility for in-home use and positive usability ratings. Conclusions: The SSS intergenerational game provides a unique addition to the limited cadre of home-based programs that facilitate parent involvement in influencing young adolescent behaviors and reducing adolescent sexual risk taking. The IM framework provided a logical and thorough approach to development and testing, attentive to the need for theoretical and empirical foundations in serious games for health. UR - http://games.jmir.org/2021/1/e23088/ UR - http://dx.doi.org/10.2196/23088 UR - http://www.ncbi.nlm.nih.gov/pubmed/33502323 ID - info:doi/10.2196/23088 ER - TY - JOUR AU - Pimentel, Juan AU - Cockcroft, Anne AU - Andersson, Neil PY - 2020/8/31 TI - Impact of Co-Designed Game Learning on Cultural Safety in Colombian Medical Education: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e17297 VL - 9 IS - 8 KW - transformative learning KW - medical education KW - cultural safety KW - participatory research KW - game jam N2 - Background: Cultural safety encourages practitioners to examine how their own culture shapes their clinical practice and to respect their patients? worldviews. Lack of cultural safety in health care is linked to stigma and discrimination toward culturally diverse patients. Training in cultural safety poses considerable challenges. It is an unappealing subject for medical students and requires behavioral changes in their clinical practice. Game jams?collaborative workshops to create and play games?have recently shown effectiveness and engaging potential in university-level education. Objective: The trial aims to determine if medical students? participation in a game jam to design an educational game on cultural safety is more effective than a standard lesson on cultural safety in terms of change in the students? self-reported intended patient-oriented behavior. Methods: A parallel-group, 2-arm randomized controlled trial with a 1:1 allocation ratio will randomize 340 medical students and 60 medical interns (n=400) at the Faculty of Medicine at La Sabana University, Colombia (170 students and 30 medical interns to each arm). The intervention group will participate in an 8-hour game jam comprising (1) a preliminary lecture on cultural safety and game design, (2) a game building session where groups of students will create educational games about cultural safety, and (3) a play-test session in which students will play and learn from each other?s games. The control group will receive a standard lesson, including a 2-hour lecture on cultural safety, followed by a 6-hour workshop to create posters about cultural safety. Web-based self-administered 30-item Likert-type questionnaires will assess cultural safety self-reported intended behavior before, immediately after, and 6 months after the intervention. An intention-to-treat approach will use a t-test with 95% CIs to determine the significance of the effect of the intervention, including within- and between-group comparisons. The qualitative most significant change technique will explore the impact of the intervention on the clinical experience of the students. Results: Study enrollment began in July 2019. A total of 531 students completed the baseline survey and were randomized. Data collection is expected to be complete by July 2020, and results are expected in October 2020. The study was approved by the institutional review board of the Faculty of Medicine at McGill University (May 31, 2017) and by the Subcommittee for Research of the Faculty of Medicine at La Sabana University (approval number 445). Conclusions: The research will develop participatory methods in game-based learning co-design that might be relevant to other subjects. Ultimately, it should foster improved cultural safety skills for medical students, improve the quality of health services for diverse cultural groups, and contribute to enhanced population health. Game learning may provide an innovative solution to a long-standing and neglected problem in medical education, helping to meet the educational expectations and needs of millennial medical students. Trial Registration: ISRCTN Registry ISRCTN14261595; http://www.controlled-trials.com/ISRCTN14261595 UR - https://www.researchprotocols.org/2020/8/e17297 UR - http://dx.doi.org/10.2196/17297 UR - http://www.ncbi.nlm.nih.gov/pubmed/32442146 ID - info:doi/10.2196/17297 ER - TY - JOUR AU - Shen, Jiabin AU - Xiang, Henry AU - Luna, John AU - Grishchenko, Alice AU - Patterson, Jeremy AU - Strouse, V. Robert AU - Roland, Maxwell AU - Lundine, P. Jennifer AU - Koterba, H. Christine AU - Lever, Kimberly AU - Groner, I. Jonathan AU - Huang, Yungui AU - Lin, Deborah En-Ju PY - 2020/8/25 TI - Virtual Reality?Based Executive Function Rehabilitation System for Children With Traumatic Brain Injury: Design and Usability Study JO - JMIR Serious Games SP - e16947 VL - 8 IS - 3 KW - traumatic brain injury KW - virtual reality KW - neurological rehabilitation KW - executive function KW - cognitive rehabilitation N2 - Background: Traumatic brain injury (TBI) poses a significant threat to children?s health. Cognitive rehabilitation for pediatric TBI has the potential to improve the quality of life following the injury. Virtual reality (VR) can provide enriched cognitive training in a life-like but safe environment. However, existing VR applications for pediatric TBIs have primarily focused on physical rehabilitation. Objective: This study aims to design and develop an integrative hardware and software VR system to provide rehabilitation of executive functions (EF) for children with TBI, particularly in 3 core EF: inhibitory control, working memory, and cognitive flexibility. Methods: The VR training system was developed by an interdisciplinary team with expertise in best practices of VR design, developmental psychology, and pediatric TBI rehabilitation. Pilot usability testing of this novel system was conducted among 10 healthy children and 4 children with TBIs. Results: Our VR-based interactive cognitive training system was developed to provide assistive training on core EF following pediatric TBI. Pilot usability testing showed adequate user satisfaction ratings for both the hardware and software components of the VR system. Conclusions: This project designed and tested a novel VR-based system for executive function rehabilitation that is specifically adapted to children following TBI. UR - http://games.jmir.org/2020/3/e16947/ UR - http://dx.doi.org/10.2196/16947 UR - http://www.ncbi.nlm.nih.gov/pubmed/32447275 ID - info:doi/10.2196/16947 ER - TY - JOUR AU - Wong, S. Rosa AU - Tung, TS Keith AU - Wong, Tung Hiu AU - Ho, KW Frederick AU - Wong, Sang Hing AU - Fu, King-Wa AU - Pong, Chuen Ting AU - Chan, Ling Ko AU - Chow, Bong Chun AU - Ip, Patrick PY - 2020/6/12 TI - A Mobile Game (Safe City) Designed to Promote Children?s Safety Knowledge and Behaviors: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e17756 VL - 9 IS - 6 KW - serious game KW - safety training KW - mobile game KW - mobile phone KW - injury prevention KW - randomized controlled trial KW - game-based intervention N2 - Background: Children have high levels of curiosity and eagerness to explore. This makes them more vulnerable to danger and hazards, and they thus have a higher risk of injury. Safety education such as teaching safety rules and tips is vital to prevent children from injuries. Although game-based approaches have the potential to capture children?s attention and sustain their interest in learning, whether these new instructional approaches are more effective than traditional approaches in delivering safety messages to children remains uncertain. Objective: The aim of this study is to test the effectiveness of a game-based intervention in promoting safety knowledge and behaviors among Hong Kong school children in Grades 4-6. It will also examine the potential effect of the game-based intervention on these children?s functioning and psychosocial difficulties. Methods: This study comprises the development of a city-based role-playing game Safe City, where players are immersed as safety inspectors to prevent dangerous situations and promote safety behavior in a virtual city environment. The usability and acceptability tests will be conducted with children in Grades 4-6 who will trial the gameplay on a mobile phone. Adjustments will be made based on their feedback. A 4-week randomized controlled trial with children studying in Grades 4-6 in Hong Kong elementary schools will be conducted to assess the effectiveness of the Safe City game?based intervention. In this trial, 504 children will play Safe City, and 504 children will receive traditional instructional materials (electronic and printed safety information). The evaluation will be conducted using both child self-report and parent proxy-report data. Specifically, child safety knowledge and behaviors will be assessed by a questionnaire involving items on knowledge and behaviors, respectively, for home safety, road safety, and sport-related safety; child functioning will be assessed by PedsQL Generic Core Scales; and psychosocial difficulties will be assessed by the Strength and Difficulties Questionnaire. These questionnaires will be administered at 3 time points: before, 1 month, and 3 months after the intervention. Game usage statistics will also be reviewed. Results: This project was funded in September 2019. The design and development of the Safe City game are currently under way. Recruitment and data collection will begin from September 2020 and will continue up to March 1, 2021. Full analysis will be conducted after the end of the data collection period. Conclusions: If the Safe City game is found to be an effective tool to deliver safety education, it could be used to promote safety in children in the community and upgraded to incorporate more health-related topics to support education and empowerment for the larger public. Trial Registration: ClinicalTrials.gov NCT04096196; https://clinicaltrials.gov/ct2/show/NCT04096196 International Registered Report Identifier (IRRID): PRR1-10.2196/17756 UR - http://www.researchprotocols.org/2020/6/e17756/ UR - http://dx.doi.org/10.2196/17756 UR - http://www.ncbi.nlm.nih.gov/pubmed/32530436 ID - info:doi/10.2196/17756 ER - TY - JOUR AU - Kihal Talantikite, Wahida AU - Renou, Damien AU - Magdelaine, Arnold AU - Harang, William AU - Zmirou-Navier, Denis AU - Deguen, Severine PY - 2020/1/7 TI - Development of Serious Games (Equit?Game) to Address Health and Environmental Inequalities: Protocol for an App-Delivered Program to Perform a Territorial Diagnosis JO - JMIR Res Protoc SP - e11786 VL - 9 IS - 1 KW - serious game KW - territorial diagnosis tool KW - health inequality KW - environmental inequalities KW - Equit'Game N2 - Background: Territorial diagnosis is a prerequisite for local actions concerning public health and for the reduction of social, environmental, and health-related inequalities. To orient local programs or initiatives targeting health inequalities, policymakers need a simulation of territorial diagnosis tools. Yet, very few platforms have been developed for the purpose of guiding public authorities as they seek to reduce these social inequalities. Objective: This study aimed to describe the design and methods of the development process of a territorial diagnosis tool based on a serious game named Equit?Game that puts learners at the heart of the territorial diagnosis process, asking them to review the current state of health, environmental state, and socioeconomic state of their territory. Methods: The realistic situations employed in our serious game should encourage players, in a fun and playful manner, to (1) appropriate the data of their own territory, (2) apply their methodological knowledge in a practical way, (3) reflect on the most pertinent statistical or spatial tools for their situation, and (4) ultimately, to acquire new knowledge and skills in the use of territorial diagnosis tools with a spatial dynamic. Equit?Game was deployed over the course of a week?s training and structured into 4 levels: level 1, Dataminer (identifying relevant information to respond to the question); level 2, Analyst (selecting the appropriate method of analysis); level 3, Atlas (mapping the data); and level 4, Cluster (extraction of statistical and spatial information). Equit?Game has also been designed as a sort of virtual campus, creating a fun learning environment in which each door represents a level. Users can access Equit?Game via a platform compatible with tablets, PCs, and mobile phones. Results: In the first step, we tested our application interface designed especially for adults among a panel of local health professionals. The following are some of the most relevant points: font size and colors used, voice accompaniment in texts and messages guiding the user, clear and easy interfaces, and the change between successive game levels. In the second step, we used our application, Equit?Game, with postgraduate students from the School of Public Health (École des hautes études en santé publique). At the end of the game session, we conducted a satisfaction survey, including several items covering both the application interface and the execution of the game. Conclusions: Equit?Game was developed to help learners with the techniques of territorial diagnosis, with the aim of creating an innovative tool for public health capable of conveying educational messages and providing a structure for training. International Registered Report Identifier (IRRID): PRR1-10.2196/11786 UR - https://www.researchprotocols.org/2020/1/e11786 UR - http://dx.doi.org/10.2196/11786 UR - http://www.ncbi.nlm.nih.gov/pubmed/31909726 ID - info:doi/10.2196/11786 ER - TY - JOUR AU - Hemingway, Charlotte AU - Baja, S. Emmanuel AU - Dalmacion, V. Godafreda AU - Medina, B. Paul Mark AU - Guevara, Genesis Ernest AU - Sy, Reden Tyrone AU - Dacombe, Russell AU - Dormann, Claire AU - Taegtmeyer, Miriam PY - 2019/12/20 TI - Development of a Mobile Game to Influence Behavior Determinants of HIV Service Uptake Among Key Populations in the Philippines: User-Centered Design Process JO - JMIR Serious Games SP - e13695 VL - 7 IS - 4 KW - HIV KW - video games KW - health communication KW - persuasive communication KW - games KW - experimental KW - user-centered design N2 - Background: Opportunities in digital distribution place mobile games as a promising platform for games for health. However, designing a game that can compete in the saturated mobile games market and deliver persuasive health messages can feel like an insurmountable challenge. Although user-centered design is widely advocated, factors such as the user?s subject domain expertise, budget constraints, and poor data collection methods can restrict the benefits of user involvement. Objective: This study aimed to develop a playable and acceptable game for health, targeted at young key populations in the Philippines. Methods: Authors identified a range of user-centered design methods to be used in tandem from published literature. The resulting design process involved a phased approach, with 40 primary and secondary users engaged during the initial ideation and prototype testing stages. Selected methods included participatory design workshops, playtests, playability heuristics, and focus group discussions. Subject domain experts were allocated roles in the development team. Data were analyzed using a framework approach. Conceptual frameworks in health intervention acceptability and game design guided the analysis. In-game events were captured through the Unity Analytics service to monitor uptake and game use over a 12-month period. Results: Early user involvement revealed a strong desire for online multiplayer gameplay, yet most reported that access to this type of game was restricted because of technical and economic constraints. A role-playing game (RPG) with combat elements was identified as a very appealing gameplay style. Findings guided us to a game that could be played offline and that blended RPG elements, such as narrative and turn-based combat, with match-3 puzzles. Although the game received a positive response during playtests, gameplay was at times perceived as repetitive and predicted to only appeal to casual gamers. Knowledge transfer was predominantly achieved through interpretation of the game?s narrative, highlighting this as an important design element. Uptake of the game was positive; between December 1, 2017, and December 1, 2018, 3325 unique device installs were reported globally. Game metrics provided evidence of adoption by young key populations in the Philippines. Game uptake and use were substantially higher in regions where direct engagement with target users took place. Conclusions: User-centered design activities supported the identification of important contextual requirements. Multiple data collection methods enabled triangulation of findings to mediate the inherent biases of the different techniques. Game acceptance is dependent on the ability of the development team to implement design solutions that address the needs and desires of target users. If target users are expected to develop design solutions, they must have adequate expertise and a significant role within the development team. Facilitating meaningful partnerships between health professionals, the games industry, and end users will support the games for health industry as it matures. UR - http://games.jmir.org/2019/4/e13695/ UR - http://dx.doi.org/10.2196/13695 UR - http://www.ncbi.nlm.nih.gov/pubmed/31859673 ID - info:doi/10.2196/13695 ER - TY - JOUR AU - Lu, Shirong Amy AU - Green, C. Melanie AU - Thompson, Debbe PY - 2019/11/21 TI - Using Narrative Game Design to Increase Children?s Physical Activity: Exploratory Thematic Analysis JO - JMIR Serious Games SP - e16031 VL - 7 IS - 4 KW - narrative KW - physical activity KW - active game KW - children KW - thematic analysis N2 - Background: Physical activity is crucial for child obesity prevention and intervention. Narratives embedded in active games can increase children?s physical activity. Objective: Little is known about the narrative characteristics that would motivate children to exercise. We attempted to fill the gaps in understanding regarding narrative design for active video games. Methods: In this exploratory study, four animated narratives of different genres were professionally generated. Children (N=41) between the ages of 8 and 12 years were interviewed to identify their preferences. Sessions were digitally recorded, transcribed, and analyzed using exploratory thematic analysis. Results: Findings revealed that the children rated the dystopian science fiction story as their favorite across all weight, race, and gender groups. The physical activity-friendly narrative strategies included virtuous characters, extraordinary character actions, interesting plots, super powers, and engaging cliffhangers. Alternatively, information not related to physical activity, difficult-to-follow plot lines, passive protagonists, and repetitive narrative tropes were less appealing for physical activity. Conclusions: This research provides preliminary evidence that narratives have characteristics that may increase child physical activity when playing active games. Future empirical studies should verify and test these design principles. UR - http://games.jmir.org/2019/4/e16031/ UR - http://dx.doi.org/10.2196/16031 UR - http://www.ncbi.nlm.nih.gov/pubmed/31750833 ID - info:doi/10.2196/16031 ER - TY - JOUR AU - Terrill, L. Alexandra AU - MacKenzie, J. Justin AU - Reblin, Maija AU - Einerson, Jackie AU - Ferraro, Jesse AU - Altizer, Roger PY - 2019/9/6 TI - A Collaboration Between Game Developers and Rehabilitation Researchers to Develop a Web-Based App for Persons With Physical Disabilities: Case Study JO - JMIR Rehabil Assist Technol SP - e13511 VL - 6 IS - 2 KW - spinal cord injury KW - software design KW - interdisciplinary health team KW - rehabilitation KW - internet N2 - Background: Individuals with a disability and their partners, who often provide care, are both at risk for depression and lower quality of life. Mobile health (mHealth) interventions are promising to address barriers to mental health care. Rehabilitation researchers and software development researchers must collaborate effectively with each other and with clinical and patient stakeholders to ensure successful mHealth development. Objective: This study aimed to aid researchers interested in mHealth software development by describing the collaborative process between a team of rehabilitation researchers, software development researchers, and stakeholders. Thus, we provide a framework (conceptual model) for other teams to replicate to build a Web-based mHealth app for individuals with physical disability. Methods: Rehabilitation researchers, software development researchers, and stakeholders (people with physical disabilities and clinicians) are involved in an iterative software development process. The overall process of developing an mHealth intervention includes initial development meetings and a co-design method called design box, in which the needs and key elements of the app are discussed. On the basis of the objectives outlined, a prototype is developed and goes through scoping iterations with feedback from stakeholders and end users. The prototype is then tested by users to identify technical errors and gather feedback on usability and accessibility. Results: Illustrating the overall development process, we present a case study based on our experience developing an app (SupportGroove) for couples coping with spinal cord injury. Examples of how we addressed specific challenges are also included. For example, feedback from stakeholders resulted in development of app features for individuals with limited functional ability. Initial designs lacked accessibility design principles made visible by end users. Solutions included large text, single click, and minimal scrolling to facilitate menu navigation for individuals using eye gaze technology. Prototype testing allowed further refinement and demonstrated high usability and engagement with activities in the app. Qualitative feedback indicated high levels of satisfaction, accessibility, and confidence in potential utility. We also present key lessons learned about working in a collaborative interdisciplinary team. Conclusions: mHealth promises to help overcome barriers to mental health intervention access. However, the development of these interventions can be challenging because of the disparate and often siloed expertise required. By describing the mHealth software development process and illustrating it with a successful case study of rehabilitation researchers, software development researchers, and stakeholders collaborating effectively, our goal is to help other teams avoid challenges we faced and benefit from our lessons learned. Ultimately, good interdisciplinary collaboration will benefit individuals with disabilities and their families. UR - http://rehab.jmir.org/2019/2/e13511/ UR - http://dx.doi.org/10.2196/13511 UR - http://www.ncbi.nlm.nih.gov/pubmed/31573927 ID - info:doi/10.2196/13511 ER - TY - JOUR AU - Santos, Oliveira Luciano Henrique De AU - Okamoto, Kazuya AU - Funghetto, Schwerz Silvana AU - Cavalli, Schüler Adriana AU - Hiragi, Shusuke AU - Yamamoto, Goshiro AU - Sugiyama, Osamu AU - Castanho, Denise Carla AU - Aoyama, Tomoki AU - Kuroda, Tomohiro PY - 2019/07/22 TI - Effects of Social Interaction Mechanics in Pervasive Games on the Physical Activity Levels of Older Adults: Quasi-Experimental Study JO - JMIR Serious Games SP - e13962 VL - 7 IS - 3 KW - aged KW - physical activity KW - pervasive games KW - social interaction N2 - Background: The novel genre of pervasive games, which aim to create more fun and engaging experiences by promoting deeper immersion, could be a powerful strategy to stimulate physical activity among older adults. To use these games more effectively, it is necessary to understand how different design elements affect player behavior. Objective: The aim was to vary a specific design element of pervasive games for older adults, namely social interaction, to test the effect on levels of physical activity. Methods: Over 4 weeks, two variations of the same pervasive game were compared: social interaction for the test group and no social interaction for the control group. In both versions, players had to walk to physical locations and collect virtual cards, but the social interaction version allowed people to collaborate to obtain more cards. Weekly step counts were used to evaluate the effect on each group, and the number of places visited was used as an indicator of play activity. Results: A total of 32 participants were recruited (no social interaction=15, social interaction=17); 18 remained until the end of the study (no social interaction=7, social interaction=11). Step counts during the first week were used as the baseline (no social interaction: mean 17,099.4, SE 3906.5; social interaction: mean 17,981.9, SE 2171.1). For the following weeks, changes to individual baseline were as follows for no social interaction (absolute/proportional): 383.8 (SE 563.8)/1.1% (SE 4.3%), 435.9 (SE 574.5)/2.2% (SE 4.6%), and ?106.1 (SE 979.9)/?2.6% (SE 8.1%) for weeks 2, 3, and 4, respectively. For social interaction they were 3841.9 (SE 1425.4)/21.7% (SE 5.1%), 2270.6 (SE 947.1)/16.5% (SE 4.4%), and 2443.4 (SE 982.6)/17.9% (SE 4.7%) for weeks 2, 3, and 4, respectively. Analysis of group effect was significant (absolute change: ?2=.19, P=.01; proportional change: ?2=.27, P=.009). Correlation between the proportional change and the play activity was significant (r=.34, 95% CI 0.08 to 0.56), whereas for absolute change it was not. Conclusions: Social interaction design elements of the pervasive game may have some positive effects on the promotion of physical activity, although other factors might also have influenced this effect. Trial Registration: Japan Medical Association Clinical Trial Registration Number JMA-IIA00314; https://dbcentre3.jmacct.med.or.jp/JMACTR/App/JMACTRS06/JMACTRS06.aspx?seqno=7274 (Archived by WebCite at http://www.webcitation.org/761a6MVAy) UR - http://games.jmir.org/2019/3/e13962/ UR - http://dx.doi.org/10.2196/13962 UR - http://www.ncbi.nlm.nih.gov/pubmed/31333202 ID - info:doi/10.2196/13962 ER - TY - JOUR AU - Faric, Nu?a AU - Yorke, Eleanor AU - Varnes, Laura AU - Newby, Katie AU - Potts, WW Henry AU - Smith, Lee AU - Hon, Adrian AU - Steptoe, Andrew AU - Fisher, Abigail PY - 2019/06/17 TI - Younger Adolescents? Perceptions of Physical Activity, Exergaming, and Virtual Reality: Qualitative Intervention Development Study JO - JMIR Serious Games SP - e11960 VL - 7 IS - 2 KW - exercise KW - obesity KW - video games KW - adolescent KW - adolescence KW - sports KW - health KW - leisure activities KW - virtual reality N2 - Background: Novel strategies to promote physical activity (PA) in adolescence are required. The vEngage study aims to test whether a virtual reality (VR) exergaming intervention can engage younger adolescents (aged 13 to 15 years) with PA. Objective: This study aimed to gather adolescents? views of using VR to encourage PA and identify the key features they would like to see in a VR exergaming intervention via interviews. Methods: Participants were recruited through 2 schools in London, United Kingdom. Semistructured interviews were conducted with adolescents about their views on PA and what might work to increase PA, technology, knowledge and experience of VR, and desired features in a VR exergaming intervention. Data were analyzed using Framework Analysis. Results: A total of 31 participants aged between 13 and 15 years (58% female, 62% from nonwhite ethnicities) participated in this interview study. The vast majority had no awareness of government PA recommendations but felt they should be more thoroughly informed. All participants were positive about the use of VR in PA promotion. Rewards, increasing challenges, and a social or multiplayer aspect were identified by participants as crucial aspects to include in a VR exercise game. Barriers were related to cost of high-end systems. Being able to exercise at home was very appealing. VR exergaming was viewed as a way to overcome multiple perceived social and cultural barriers to PA, particularly for girls. Conclusions: Key elements that should be incorporated into a VR game for health intervention were identified and described. These also included the use of rewards, novelty and enjoyment in immersive game play, multiplayer options, and real-world elements, as well as continual updates and new challenge levels. The use of VR to promote PA in adolescents is promising, but some barriers were raised. UR - http://games.jmir.org/2019/2/e11960/ UR - http://dx.doi.org/10.2196/11960 UR - http://www.ncbi.nlm.nih.gov/pubmed/31210135 ID - info:doi/10.2196/11960 ER - TY - JOUR AU - Winskell, Kate AU - Sabben, Gaëlle AU - Obong'o, Christopher PY - 2019/05/08 TI - Interactive Narrative in a Mobile Health Behavioral Intervention (Tumaini): Theoretical Grounding and Structure of a Smartphone Game to Prevent HIV Among Young Africans JO - JMIR Serious Games SP - e13037 VL - 7 IS - 2 KW - mHealth KW - serious games KW - games for health KW - narrative KW - HIV KW - adolescence KW - sub-Saharan Africa KW - behavioral theory KW - narrative theory UR - http://games.jmir.org/2019/2/e13037/ UR - http://dx.doi.org/10.2196/13037 UR - http://www.ncbi.nlm.nih.gov/pubmed/31066692 ID - info:doi/10.2196/13037 ER - TY - JOUR AU - Verschueren, Sarah AU - Buffel, Connor AU - Vander Stichele, Geert PY - 2019/05/02 TI - Developing Theory-Driven, Evidence-Based Serious Games for Health: Framework Based on Research Community Insights JO - JMIR Serious Games SP - e11565 VL - 7 IS - 2 KW - health KW - computer games KW - digital KW - intervention KW - review KW - methodology N2 - Background: The idea of using serious games to effectuate better outcomes in health care has gained significant traction among a growing community of researchers, developers, and health care professionals. Many now recognize the importance of creating evidence-based games that are purposefully designed to address physical and mental health challenges faced by end users. To date, no regulatory resources have been established to guide the development of serious games for health (SGH). Developers must therefore look elsewhere for guidance. Although a more robust level of evidence exists in the research literature, it is neither structured nor is there any clear consensus. Developers currently use a variety of approaches and methodologies. The establishment of a well-defined framework that represents the consensus views of the SGH research community would help developers improve the efficiency of internal development processes, as well as chances of success. A consensus framework would also enhance the credibility of SGH and help provide quality evidence of their effectiveness. Objective: This research aimed to (1) identify and evaluate the requirements, recommendations, and guidelines proposed by the SGH community in the research literature, and; (2) develop a consensus framework to guide developers, designers, researchers, and health care professionals in the development of evidence-based SGH. Methods: A critical review of the literature was performed in October to November 2018. A 3-step search strategy and a predefined set of inclusion criteria were used to identify relevant articles in PubMed, ScienceDirect, Institute of Electrical and Electronics Engineers Xplore, CiteSeerX, and Google Scholar. A supplemental search of publications from regulatory authorities was conducted to capture their specific requirements. Three researchers independently evaluated the identified articles. The evidence was coded and categorized for analysis. Results: This review identified 5 categories of high-level requirements and 20 low-level requirements suggested by the SGH community. These advocate a methodological approach that is multidisciplinary, iterative, and participatory. On the basis of the requirements identified, we propose a framework for developing theory-driven, evidence-based SGH. It comprises 5 stages that are informed by various stakeholders. It focuses on building strong scientific and design foundations that guide the creative and technical development. It includes quantitative trials to evaluate whether the SGH achieve the intended outcomes, as well as efforts to disseminate trial findings and follow-up monitoring after the SGH are rolled out for use. Conclusions: This review resulted in the formulation of a framework for developing theory-driven, evidence-based SGH that represents many of the requirements set out by SGH stakeholders in the literature. It covers all aspects of the development process (scientific, technological, and design) and is transparently described in sufficient detail to allow SGH stakeholders to implement it in a wide variety of projects, irrespective of discipline, health care segments, or focus. UR - https://games.jmir.org/2019/2/e11565/ UR - http://dx.doi.org/10.2196/11565 UR - http://www.ncbi.nlm.nih.gov/pubmed/31045496 ID - info:doi/10.2196/11565 ER - TY - JOUR AU - Fordham, Joseph AU - Ball, Christopher PY - 2019/04/18 TI - Framing Mental Health Within Digital Games: An Exploratory Case Study of Hellblade JO - JMIR Ment Health SP - e12432 VL - 6 IS - 4 KW - video games KW - electronic gaming KW - psychosis KW - stigma N2 - Background: Researchers and therapists have increasingly turned to digital games for new forms of treatments and interventions for people suffering from a variety of mental health issues. Yet, the depiction of mental illness within digital games typically promotes stigmatized versions of those with mental health concerns. Recently, more games have attempted to implement more realistic and respectful depictions of mental health conditions. Objective: This paper presents an exploratory analysis of a contemporary game that has the potential to change the way researchers, practitioners, and game designers approach topics of mental health within the context of gaming. Methods: A case study of Hellblade: Senua's Sacrifice was conducted using frame analysis to show how key design choices for this game present the potential for new ways of approaching games and mental health. Results: A case study of Hellblade?s development shows how research-informed collaborative design with mental health practitioners, scientists, and individuals with mental health problems can lead to a realistic depiction of mental illness in games. Furthermore, the use of frame analysis demonstrates how to harness narrative, mechanics, and technology to create embodied experiences of mental health, which has the potential to promote empathetic understanding. Conclusions: This paper highlights an exemplary case of collaborative commercial game design for entertainment purposes in relation to mental health. Understanding the success of Hellblade's depiction of psychosis can improve serious games research and design. Further research must continue to provide deeper analysis of not only games that depict mental illness, but also the design process behind them. UR - http://mental.jmir.org/2019/4/e12432/ UR - http://dx.doi.org/10.2196/12432 UR - http://www.ncbi.nlm.nih.gov/pubmed/30998224 ID - info:doi/10.2196/12432 ER - TY - JOUR AU - Jones, Matthew AU - Denisova, Alena AU - Mitchell, Stephen AU - Owen, Tom PY - 2019/04/16 TI - Acceptability of a Plasticity-Focused Serious Game Intervention for Posttraumatic Stress Disorder: User Requirements Analysis JO - JMIR Serious Games SP - e11909 VL - 7 IS - 2 KW - PTSD KW - mobile applications KW - neuronal plasticity KW - cognitive behavioral therapy N2 - Background: Trauma-focused cognitive behavioral therapy (TF-CBT) is a first-line treatment for posttraumatic stress disorder (PTSD). Despite a solid evidence base, TF-CBT response and attrition rates vary considerably. Plasticity-focused interventions, including the use of serious games, have the potential to improve TF-CBT response and treatment retention. Objective: The aim of this study was to assess the acceptability of a mobile phone?delivered plasticity-focused serious game to improve response to TF-CBT for PTSD, and carry out a user requirements analysis should the development of a prototype be warranted. Methods: We conducted 2 one-to-one interviews (n=2), one focus group involving service users who had received a diagnosis of PTSD (n=3) and one focus group involving psychological trauma service clinicians (n=4). Results: We found that the concept of a plasticity-focused mobile phone intervention for PTSD is acceptable to patients and clinicians. Service users and clinicians both believed that the usage should be guided by a therapist, and both contributed useful inputs regarding the audiovisual aspects of the proposed serious game. It was accepted that the game would not be suitable for all patients and that clinicians would need to appropriately prescribe the usage of the game. Conclusions: The findings highlight the acceptability of the proposed serious game and clarify the user requirements for such an intervention. It is the intention of the authors to carry out a user experience evaluation using a prototype serious game in a clinical population. UR - http://games.jmir.org/2019/2/e11909/ UR - http://dx.doi.org/10.2196/11909 UR - http://www.ncbi.nlm.nih.gov/pubmed/30990461 ID - info:doi/10.2196/11909 ER - TY - JOUR AU - Whiteley, Laura AU - Mena, Leandro AU - Craker, K. Lacey AU - Healy, Garver Meredith AU - Brown, K. Larry PY - 2019/03/27 TI - Creating a Theoretically Grounded Gaming App to Increase Adherence to Pre-Exposure Prophylaxis: Lessons From the Development of the Viral Combat Mobile Phone Game JO - JMIR Serious Games SP - e11861 VL - 7 IS - 1 KW - cell phone KW - HIV KW - young adult KW - sexual and gender minorities N2 - Background: In the United States, young minority men who have sex with men (MSM) are most likely to become infected with HIV. The use of antiretroviral medications to reduce the risk of acquiring HIV infection (pre-exposure prophylaxis, PrEP) is an efficacious and promising prevention strategy. There have been significant advances regarding PrEP, including the definitive demonstration that PrEP reduces HIV acquisition and the development of clinical prescribing guidelines. Despite these promising events, the practical implementation of PrEP can be challenging. Data show that PrEP?s safety and effectiveness could be greatly compromised by suboptimal adherence to treatment, and there is concern about the potential for an increase in HIV risk behavior among PrEP users. Due to these challenges, the prescribing of PrEP should be accompanied by behavioral interventions to promote adherence. Objective: This study aimed to develop an immersive, action-oriented iPhone gaming intervention to improve motivation for adherence to PrEP. Methods: Game development was guided by social learning theory, taking into consideration the perspectives of young adult MSM who are taking PrEP. A total of 20 young men who have sex with men (YMSM; aged 18-35 years) were recruited from a sexually transmitted infection (STI), HIV testing, and PrEP care clinic in Jackson, Mississippi, between October 2016 and June 2017. They participated in qualitative interviews guided by the information-motivation-behavioral skills (IMB) model of behavior change. The mean age of participants was 26 years, and all the participants identified as male. Acceptability of the game was assessed with the Client Service Questionnaire and session evaluation form. Results: A number of themes emerged that informed game development. YMSM taking PrEP desired informational game content that included new and comprehensive details about the effectiveness of PrEP, details about PrEP as it relates to doctors? visits, and general information about STIs other than HIV. Motivational themes that emerged were the desire for enhancement of future orientation; reinforcement of positive influences from partners, parents, and friends; collaboration with health care providers; decreasing stigma; and a focus on personal relevance of PrEP-related medical care. Behavioral skills themes centered around self-efficacy and strategies for adherence to PrEP and self-care. Conclusions: We utilized youth feedback, IMB, and agile software development to create a multilevel, immersive, action-oriented iPhone gaming intervention to improve motivation for adherence to PrEP. There is a dearth of gaming interventions for persons on PrEP. This study is a significant step in working toward the development and testing of an iPhone gaming intervention to decrease HIV risk and promote adherence to PrEP for YMSM. UR - http://games.jmir.org/2019/1/e11861/ UR - http://dx.doi.org/10.2196/11861 UR - http://www.ncbi.nlm.nih.gov/pubmed/30916652 ID - info:doi/10.2196/11861 ER - TY - JOUR AU - Tuijnman, Anouk AU - Kleinjan, Marloes AU - Hoogendoorn, Evert AU - Granic, Isabela AU - Engels, CME Rutger PY - 2019/03/14 TI - A Game-Based School Program for Mental Health Literacy and Stigma Regarding Depression (Moving Stories): Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e11255 VL - 8 IS - 3 KW - depression KW - help-seeking behavior KW - helping behavior KW - health literacy KW - stigma KW - video games KW - adolescence KW - secondary schools N2 - Background: The prevalence of elevated depressive symptoms among youth in most western societies is high. Yet, most adolescents who are experiencing depressive symptoms do not seek help. Low mental health literacy, high stigma, and low social support have been shown to hinder help-seeking. A small number of interventions has been developed to target mental health literacy and stigma, but few focus on actual help-seeking and first aid behavior. We have developed a game-based school program called Moving Stories that targets mental health literacy, including knowledge and behavior, and stigma among adolescents, in regard to depression specifically. Objective: Our aim is to describe the protocol for a study that will test the effectiveness of the program Moving Stories in a Dutch adolescent sample. We hypothesize that adolescents who participate in the program Moving Stories will have better mental health literacy and less stigma regarding depression compared to adolescents in the nonintervention control group at posttest and at 3- and 6-months follow-up. We also expect a positive change in actual help-seeking and first aid behavior at 3- and 6-months follow-up. Methods: Moving Stories has been developed by a professional game design company in collaboration with researchers and relevant stakeholders. The effectiveness of Moving Stories will be tested through a randomized controlled trial with two conditions: Moving Stories versus control. Participants will fill in questionnaires at pretest, posttest, and 3- and 6-months follow-up. Our power analysis showed a required sample size of 180 adolescents. Results: Four high schools have agreed to participate with a total of 10 classes. A total of 185 adolescents filled in the pretest questionnaire. The last of the follow-up data was collected in December 2018. Conclusions: If Moving Stories proves to be effective, it could be implemented as a school-based program to target mental health literacy and stigma regarding depression; this could, in turn, improve early help-seeking in adolescents suffering from depression. Trial Registration: Nederlands Trial Register NTR7033; https://www.trialregister.nl/trial/6855 International Registered Report Identifier (IRRID): DERR1-10.2196/11255 UR - https://www.researchprotocols.org/2019/3/e11255/ UR - http://dx.doi.org/10.2196/11255 UR - http://www.ncbi.nlm.nih.gov/pubmed/30869652 ID - info:doi/10.2196/11255 ER - TY - JOUR AU - Park, Sungjin AU - Kim, Sangkyun PY - 2018/11/06 TI - Patterns Among 754 Gamification Cases: Content Analysis for Gamification Development JO - JMIR Serious Games SP - e11336 VL - 6 IS - 4 KW - gamification KW - PLEX KW - game mechanics KW - gamification correlation analysis KW - 4F process N2 - Background: Gamification is one of the techniques that applies game elements, such as game mechanics and dynamics, to a nongame context (eg, management, education, marketing, and health care). A variety of methodologies have been published for developing gamification. However, some of these are only usable by people with a certain level of gamification knowledge. People who do not have such knowledge face difficulty in using game mechanics and experiencing enjoyment. To ease their difficulties, a gamification methodology should provide directions for using game mechanics. Objective: This study aimed at collecting global gamification cases and determining patterns or differences among the collected cases. Methods: In total, 754 cases were collected based on 4F process elements, such as play type, playful user experience (PLEX)?based fun factors, and game mechanics. In addition, the collected cases were classified into 6 categories. From the data analysis, basic statistics and correlation analyses (Pearson and Kendall) were conducted. Results: According to the analysis results in PLEX-based fun factors, challenge and completion fun factors formed a large proportion among the 6 categories. In the results of the game mechanics analysis, point, leaderboard, and progress accounted for a large proportion among the 6 categories. The results of the correlation analysis showed no difference or specific patterns in game mechanics (Pearson r>.8, Kendall ?>.5, P<.05) and PLEX-based fun factors (Pearson r>.8, Kendall ?>.7, P<.05). Conclusions: On the basis of the statistical findings, this study suggests an appropriate number of PLEX-based fun factors and game mechanics. In addition, the results of this study should be used for people who do not have gamification knowledge and face difficulty using game mechanics and PLEX-based fun factors. UR - http://games.jmir.org/2018/4/e11336/ UR - http://dx.doi.org/10.2196/11336 UR - http://www.ncbi.nlm.nih.gov/pubmed/30401666 ID - info:doi/10.2196/11336 ER -