TY - JOUR AU - Maxim, Ionela Raluca AU - Arnedo-Moreno, Joan PY - 2025/3/5 TI - Identifying Key Principles and Commonalities in Digital Serious Game Design Frameworks: Scoping Review JO - JMIR Serious Games SP - e54075 VL - 13 KW - entertainment game design frameworks KW - serious game design frameworks KW - design principles KW - empathic design thinking KW - artificial intelligence N2 - Background: Digital serious games (DSGs), designed for purposes beyond entertainment and consumed via electronic devices, have garnered attention for their potential to enhance learning and promote behavior change. Their effectiveness depends on the quality of their design. Frameworks for DSG design can guide the creation of engaging games tailored to objectives such as education, health, and social impact. Objective: This study aims to review, analyze, and synthesize the literature on digital entertainment game design frameworks and DSG design frameworks (DSGDFWs). The focus is on conceptual frameworks offering high-level guidance for the game creation process rather than component-specific tools. We explore how these frameworks can be applied to create impactful serious games in fields such as health care and education. Key goals include identifying design principles, commonalities, dependencies, gaps, and opportunities in the literature. Suggestions for future research include empathic design thinking, artificial intelligence integration, and iterative improvements. The findings culminate in a synthesized 4-phase design process, offering generic guidelines for designers and developers to create effective serious games that benefit society. Methods: A 2-phase methodology was used: a scoping literature review and cluster analysis. A targeted search across 7 databases (ACM, Scopus, Springer, IEEE, Elsevier, JMIR Publications, and SAGE) was conducted using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines. Studies included academic or industry papers evaluating digital game design frameworks. Cluster analysis was applied to categorize the data, revealing trends and correlations among frameworks. Results: Of 987 papers initially identified, 25 (2.5%) met the inclusion criteria, with an additional 22 identified through snowballing, resulting in 47 papers. These papers presented 47 frameworks, including 16 (34%) digital entertainment game design frameworks and 31 (66%) DSGDFWs. Thematic analysis grouped frameworks into categories, identifying patterns and relationships between design elements. Commonalities, dependencies, and gaps were analyzed, highlighting opportunities for empathic design thinking and artificial intelligence applications. Key considerations in DSG design were identified and presented in a 4-phase design baseline with the outcome of a list of design guidelines that might, according to the literature, be applied to an end-to-end process of designing and building future innovative solutions. Conclusions: The main benefits of using DSGDFWs seem to be related to enhancing the effectiveness of serious games in achieving their intended objectives, such as learning, behavior change, and social impact. Limitations primarily seem to be related to constraints associated with the specific contexts in which the serious games are developed and used. Approaches in the future should be aimed at refining and adapting existing frameworks to different contexts and purposes, as well as exploring new frameworks that incorporate emerging technologies and design principles. UR - https://games.jmir.org/2025/1/e54075 UR - http://dx.doi.org/10.2196/54075 UR - http://www.ncbi.nlm.nih.gov/pubmed/40053743 ID - info:doi/10.2196/54075 ER - 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 - González-Cabrera, Joaquín AU - Caba-Machado, Vanessa AU - Díaz-López, Adoración AU - Jiménez-Murcia, Susana AU - Mestre-Bach, Gemma AU - Machimbarrena, M. Juan PY - 2024/9/20 TI - The Mediating Role of Problematic Use of Loot Boxes Between Internet Gaming Disorder and Online Gambling Disorder: Cross-Sectional Analytical Study JO - JMIR Serious Games SP - e57304 VL - 12 KW - loot boxes KW - loot box KW - gaming KW - gambling KW - problematic KW - video games KW - game KW - games KW - addict KW - addiction KW - addictions KW - addictive KW - internet KW - virtual object KW - virtual objects KW - gamification KW - IGD KW - OGD KW - monetize KW - monetization KW - reward KW - rewards KW - incentive KW - incentives KW - internet gaming disorder KW - online gambling disorder N2 - Background: The video game industry has introduced a new form of monetization through microtransactions. A controversial example has been the so-called ?loot boxes? (LBs) as virtual objects, which are randomized and bought with legal money. In recent years, LBs have come to connect 2 distinct problem behaviors, namely internet gaming disorder (IGD) and online gambling disorder (OGD). Many association studies have been conducted on the 3 constructs, but few have delved into the relationship of problematic use of LBs (PU-LB) with IGD and OGD. Objective: This study aims to explore the mediating role of the PU-LB between IGD and OGD. Methods: This cross-sectional and analytical study used incidental sampling in 24 Spanish schools. The final sample consisted of 542 participants (male: n=523, 96.5%; age: range 11?30 y) who played video games, bought LBs, and had gambled online in the last 12 months. Participants then completed the Spanish versions of the Internet Gaming Disorder Scale?Short Form, Online Gambling Disorder Questionnaire, and PU-LB scale. Results: IGD scores were found to be significantly associated with both PU-LB (r=0.473, P<.001) and OGD (r=0.209, P<.001). Moreover, PU-LB was significantly associated with OGD (r=0.351, P<.001). The structural equation model results indicated that IGD had no significant direct effect on OGD (P=.903). However, the indirect effect of IGD on OGD through PU-LB was significant (P<.001). Therefore, PU-LB fully mediated the relationship between IGD and OGD. Furthermore, these results were found in the subsamples of both minors (<18 y) and young adults (?18 y). Conclusions: It is suggested that there is a mediation effect of problematic LB use between internet gambling and online gambling problems in both minors and young adults. This has potential practical implications by providing more evidence on how LBs have become a hinge feature between 2 clinically relevant and independent issues. In this regard, adequate industry self-regulation is needed, and effective legislation for the protection of minors is necessary. UR - https://games.jmir.org/2024/1/e57304 UR - http://dx.doi.org/10.2196/57304 ID - info:doi/10.2196/57304 ER - TY - JOUR AU - García de Alba-Chávez, Alberto Carlos AU - Espinosa-Curiel, Edrein Ismael AU - Michel-Nava, María Rosa PY - 2024/8/8 TI - Exploring the Impact of a Persuasive Serious Video Game (Farmily) on Promoting Home Gardening Among Novices: Design and Randomized Controlled Trial JO - JMIR Serious Games SP - e60771 VL - 12 KW - serious video game KW - persuasive game KW - home gardening KW - knowledge KW - attitude KW - self-efficacy KW - intention N2 - Background: Home gardens worldwide provide sustenance, economic support, and access to fresh produce and promote household well-being, health, self-sufficiency, and food security. However, they face significant challenges worldwide and necessitate innovative promotion approaches. Serious video games have proven effective in promoting agricultural knowledge. However, more research is needed on the persuasive potential of agriculture games to influence players? thoughts, attitudes, and behaviors. This provides an opportunity to examine the impact of persuasive games on promoting home gardening among novices. Objective: This study aims to describe the design and development of Farmily, a persuasive video game promoting home gardening among novices. In addition, it evaluated the effectiveness of Farmily and compared its impact with that of a traditional home gardening workshop. Furthermore, the study explored how game enjoyment relates to the game?s outcomes. Methods: A randomized controlled trial with 50 novice gardening participants aged 20 to 50 years was carried out. Participants were randomly assigned to a control group (1.5-hour workshop) or an experimental group (1.5-hour Farmily session). Pre- and postintervention assessments were conducted. We evaluated Farmily?s impact on knowledge, attitudes, perceived self-efficacy, and intentions regarding initiating home gardens. In addition, we investigated the user enjoyment and its relationship with the game?s effect outcomes. Results: The experimental group significantly improved their knowledge (t24=4.26; P<.001), attitude (z24=2.98; P=.003), self-efficacy (t24=2.6; P=.02), and intention to initiate home gardens (z24=4.15; P<.001). The experimental group showed similar effectiveness in knowledge transfer (t24=?1.71; P=.09) and a more significant impact on attitude (z24=2.73; P=.006), self-efficacy (t24=2.21; P=.03), and intention to start a home garden (t24=?5.33; P<.001) than the control group. Farmily was well received by the intervention group, generating high enjoyment. Furthermore, user enjoyment substantially correlated with user attitudes (r23=0.72; P<.001) and self-efficacy (r23=0.67; P<.001), yet no discernible association was observed among user enjoyment, knowledge (r23=0.26; P=.20), and intention (r23=0.06; P=.77). Conclusions: Evidence indicates that Farmily appears to be a viable tool for promoting home gardening among novices in the short term. Farmily demonstrated similar effects in knowledge improvement to those of a traditional workshop and had a more significant impact on the other variables. In addition, we found that the player?s gaming experience positively relates to the player?s attitudes and self-efficacy. A well-powered randomized controlled trial with more diverse samples and extended follow-up periods will be conducted to establish the long-term efficacy of Farmily and gain a deeper understanding of the influence of enjoyment on game outcomes. UR - https://games.jmir.org/2024/1/e60771 UR - http://dx.doi.org/10.2196/60771 UR - http://www.ncbi.nlm.nih.gov/pubmed/39116437 ID - info:doi/10.2196/60771 ER - TY - JOUR AU - Berglund, Aseel AU - Jaarsma, Tiny AU - Orädd, Helena AU - Fallström, Johan AU - Strömberg, Anna AU - Klompstra, Leonie AU - Berglund, Erik PY - 2024/8/7 TI - The Application of a Serious Game Framework to Design and Develop an Exergame for Patients With Heart Failure JO - JMIR Form Res SP - e50063 VL - 8 KW - mobile health apps KW - physical activity KW - exergames KW - player-centered design KW - heart failure KW - human-computer interaction KW - mobile phone UR - https://formative.jmir.org/2024/1/e50063 UR - http://dx.doi.org/10.2196/50063 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/50063 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 - Lieder, Falk AU - Chen, Pin-Zhen AU - Prentice, Mike AU - Amo, Victoria AU - To?i?, Mateo PY - 2024/3/22 TI - Gamification of Behavior Change: Mathematical Principle and Proof-of-Concept Study JO - JMIR Serious Games SP - e43078 VL - 12 KW - gamification KW - points KW - feedback KW - behavior change KW - habit formation KW - chatbot KW - digital interventions KW - mobile phone KW - artificial intelligence N2 - Background: Many people want to build good habits to become healthier, live longer, or become happier but struggle to change their behavior. Gamification can make behavior change easier by awarding points for the desired behavior and deducting points for its omission. Objective: In this study, we introduced a principled mathematical method for determining how many points should be awarded or deducted for the enactment or omission of the desired behavior, depending on when and how often the person has succeeded versus failed to enact it in the past. We called this approach optimized gamification of behavior change. Methods: As a proof of concept, we designed a chatbot that applies our optimized gamification method to help people build healthy water-drinking habits. We evaluated the effectiveness of this gamified intervention in a 40-day field experiment with 1 experimental group (n=43) that used the chatbot with optimized gamification and 2 active control groups for which the chatbot?s optimized gamification feature was disabled. For the first control group (n=48), all other features were available, including verbal feedback. The second control group (n=51) received no feedback or reminders. We measured the strength of all participants? water-drinking habits before, during, and after the intervention using the Self-Report Habit Index and by asking participants on how many days of the previous week they enacted the desired habit. In addition, all participants provided daily reports on whether they enacted their water-drinking intention that day. Results: A Poisson regression analysis revealed that, during the intervention, users who received feedback based on optimized gamification enacted the desired behavior more often (mean 14.71, SD 6.57 times) than the active (mean 11.64, SD 6.38 times; P<.001; incidence rate ratio=0.80, 95% CI 0.71-0.91) or passive (mean 11.64, SD 5.43 times; P=.001; incidence rate ratio=0.78, 95% CI 0.69-0.89) control groups. The Self-Report Habit Index score significantly increased in all conditions (P<.001 in all cases) but did not differ between the experimental and control conditions (P>.11 in all cases). After the intervention, the experimental group performed the desired behavior as often as the 2 control groups (P?.17 in all cases). Conclusions: Our findings suggest that optimized gamification can be used to make digital behavior change interventions more effective. Trial Registration: Open Science Framework (OSF) H7JN8; https://osf.io/h7jn8 UR - https://games.jmir.org/2024/1/e43078 UR - http://dx.doi.org/10.2196/43078 UR - http://www.ncbi.nlm.nih.gov/pubmed/38517466 ID - info:doi/10.2196/43078 ER - TY - JOUR AU - Vonthron, Francois AU - Yuen, Antoine AU - Pellerin, Hugues AU - Cohen, David AU - Grossard, Charline PY - 2024/1/11 TI - A Serious Game to Train Rhythmic Abilities in Children With Dyslexia: Feasibility and Usability Study JO - JMIR Serious Games SP - e42733 VL - 12 KW - serious game KW - rhythm KW - dyslexia KW - musical abilities KW - design framework KW - reading skills KW - children KW - digital health intervention KW - attention-deficit/hyperactivity disorder KW - ADHD KW - child development KW - mobile phone N2 - Background: Rhythm perception and production are related to phonological awareness and reading performance, and rhythmic deficits have been reported in dyslexia. In addition, rhythm-based interventions can improve cognitive function, and there is consistent evidence suggesting that they are an efficient tool for training reading skills in dyslexia. Objective: This paper describes a rhythmic training protocol for children with dyslexia provided through a serious game (SG) called Mila-Learn and the methodology used to test its usability. Methods: We computed Mila-Learn, an SG that makes training remotely accessible and consistently reproducible and follows an educative agenda using Unity (Unity Technologies). The SG?s development was informed by 2 studies conducted during the French COVID-19 lockdowns. Study 1 was a feasibility study evaluating the autonomous use of Mila-Learn with 2500 children with reading deficits. Data were analyzed from a subsample of 525 children who spontaneously played at least 15 (median 42) games. Study 2, following the same real-life setting as study 1, evaluated the usability of an enhanced version of Mila-Learn over 6 months in a sample of 3337 children. The analysis was carried out in 98 children with available diagnoses. Results: Benefiting from study 1 feedback, we improved Mila-Learn to enhance motivation and learning by adding specific features, including customization, storylines, humor, and increasing difficulty. Linear mixed models showed that performance improved over time. The scores were better for older children (P<.001), children with attention-deficit/hyperactivity disorder (P<.001), and children with dyslexia (P<.001). Performance improved significantly faster in children with attention-deficit/hyperactivity disorder (?=.06; t3754=3.91; P<.001) and slower in children with dyslexia (?=?.06; t3816=?5.08; P<.001). Conclusions: Given these encouraging results, future work will focus on the clinical evaluation of Mila-Learn through a large double-blind randomized controlled trial comparing Mila-Learn and a placebo game. UR - https://games.jmir.org/2024/1/e42733 UR - http://dx.doi.org/10.2196/42733 UR - http://www.ncbi.nlm.nih.gov/pubmed/37830510 ID - info:doi/10.2196/42733 ER - TY - JOUR AU - Ambros-Antemate, Fernando Jorge AU - Beristain-Colorado, Pilar María del AU - Vargas-Treviño, Marciano AU - Gutiérrez-Gutiérrez, Jaime AU - Hernández-Cruz, Antonio Pedro AU - Gallegos-Velasco, Belem Itandehui AU - Moreno-Rodríguez, Adriana PY - 2023/11/10 TI - Improving Adherence to Physical Therapy in the Development of Serious Games: Conceptual Framework Design Study JO - JMIR Form Res SP - e39838 VL - 7 KW - conceptual framework KW - serious game KW - Flow Theory KW - adherence KW - gamification KW - physical rehabilitation N2 - Background: Insufficient levels of treatment adherence can have adverse effects on the outcomes of physical rehabilitation. To address this issue, alternative approaches to traditional therapies, such as serious games, have been designed to enhance adherence. Nevertheless, there remain gaps in the development of serious games concerning the effective implementation of motivation, engagement, and the enhancement of treatment adherence. Objective: This study aims to design a conceptual framework for the development of serious games that incorporate essential adherence factors to enhance patient compliance with physical rehabilitation programs. Methods: We formulated a conceptual framework using iterative techniques inspired by a conceptual framework analysis. Initially, we conducted a comprehensive literature review, concentrating on the critical adherence factors in physical rehabilitation. Subsequently, we identified, categorized, integrated, and synthesized the concepts derived from the literature review to construct the conceptual framework. Results: The framework resembles a road map, comprising 3 distinct phases. In the initial phase, the patient?s characteristics are identified through an initial exploration. The second phase involves the development of a serious game, with a focus on enhancing treatment adherence by integrating the key adherence factors identified. The third phase revolves around the evaluation of the serious game. These phases are underpinned by 2 overarching themes, namely, a user-centered design and the GameFlow model. Conclusions: The conceptual framework offers a detailed, step-by-step guide for creating serious games that incorporate essential adherence factors, thereby contributing to improved adherence in the physical rehabilitation process. To establish its validity, further evaluations of this framework across various physical rehabilitation programs and user groups are necessary. UR - https://formative.jmir.org/2023/1/e39838 UR - http://dx.doi.org/10.2196/39838 UR - http://www.ncbi.nlm.nih.gov/pubmed/37948110 ID - info:doi/10.2196/39838 ER - TY - JOUR AU - Lukka, Lauri AU - Palva, Matias J. PY - 2023/9/4 TI - The Development of Game-Based Digital Mental Health Interventions: Bridging the Paradigms of Health Care and Entertainment JO - JMIR Serious Games SP - e42173 VL - 11 KW - digital mental health interventions KW - development frameworks KW - gamification KW - game-based interventions KW - intervention development KW - mental health KW - paradigms KW - serious games UR - https://games.jmir.org/2023/1/e42173 UR - http://dx.doi.org/10.2196/42173 UR - http://www.ncbi.nlm.nih.gov/pubmed/37665624 ID - info:doi/10.2196/42173 ER - TY - JOUR AU - Altomari, Luca AU - Altomari, Natalia AU - Iazzolino, Gianpaolo PY - 2023/7/26 TI - Gamification and Soft Skills Assessment in the Development of a Serious Game: Design and Feasibility Pilot Study JO - JMIR Serious Games SP - e45436 VL - 11 KW - gamification KW - soft skills KW - recruitment KW - serious games KW - assessment KW - process mining KW - work-life skills N2 - Background: The advent of new technologies has had a profound impact on the labor market, transforming the way we work and interact with each other. With the rise of digital tools and platforms, gamification has emerged as a powerful technique for enhancing productivity and engagement in various fields, including human resource management. In particular, gamification has been found to be effective in developing and assessing soft skills, which play a critical role in determining the success of individuals, teams, and organizations. Objective: We present a serious game that identifies the most sought-after skills in the job market and offers feedback, and we provide a set of guidelines for the creation of serious games. Methods: We present the serious game Among the Office Criticality (AOC). The AOC game structure involves a set of sequence analysis techniques, which is known as process mining. Results: The pilot study findings indicate that the game is both engaging and beneficial to subjects, suggesting that the results align with current theoretical perspectives. Furthermore, the study suggests that the obtained data can be extended to the broader population. Conclusions: This study illustrates a serious game structured according to the needs of the labor market and developed to put the user at the center, using evaluation techniques consistent with the literature, with the aim of constituting an interdisciplinary approach suitable for adequately assessing users and creating value for them. UR - https://games.jmir.org/2023/1/e45436 UR - http://dx.doi.org/10.2196/45436 UR - http://www.ncbi.nlm.nih.gov/pubmed/37494078 ID - info:doi/10.2196/45436 ER - TY - JOUR AU - Carlier, Stéphanie AU - Naessens, Vince AU - De Backere, Femke AU - De Turck, Filip PY - 2023/3/6 TI - A Software Engineering Framework for Reusable Design of Personalized Serious Games for Health: Development Study JO - JMIR Serious Games SP - e40054 VL - 11 KW - serious game KW - health care KW - personalization KW - domain knowledge KW - framework KW - eHealth KW - cocreation N2 - Background: The use of serious games in health care is on the rise, as these games motivate treatment adherence, reduce treatment costs, and educate patients and families. However, current serious games fail to offer personalized interventions, ignoring the need to abandon the one-size-fits-all approach. Moreover, these games, with a primary objective other than pure entertainment, are costly and complex to develop and require the constant involvement of a multidisciplinary team. No standardized approach exists on how serious games can be personalized, as existing literature focuses on specific use cases and scenarios. The serious game development domain fails to consider any transfer of domain knowledge, which means this labor-intensive process must be repeated for each serious game. Objective: We proposed a software engineering framework that aims to streamline the multidisciplinary design process of personalized serious games in health care and facilitates the reuse of domain knowledge and personalization algorithms. By focusing on the transfer of knowledge to new serious games by reusing components and personalization algorithms, the comparison and evaluation of different personalization strategies can be simplified and expedited. In doing so, the first steps are taken in advancing the state of the art of knowledge regarding personalized serious games in health care. Methods: The proposed framework aimed to answer 3 questions that need to be asked when designing personalized serious games: Why is the game personalized? What parameters can be used for personalization? and How is the personalization achieved? The 3 involved stakeholders, namely, the domain expert, the (game) developer, and the software engineer, were each assigned a question and then assigned responsibilities regarding the design of the personalized serious game. The (game) developer was responsible for all the game-related components; the domain expert was in charge of the modeling of the domain knowledge using simple or complex concepts (eg, ontologies); and the software engineer managed the personalization algorithms or models integrated into the system. The framework acted as an intermediate step between game conceptualization and implementation; it was illustrated by developing and evaluating a proof of concept. Results: The proof of concept, a serious game for shoulder rehabilitation, was evaluated using simulations of heart rate and game scores to assess how personalization was achieved and whether the framework responded as expected. The simulations indicated the value of both real-time and offline personalization. The proof of concept illustrated how the interaction between different components worked and how the framework was used to simplify the design process. Conclusions: The proposed framework for personalized serious games in health care identifies the responsibilities of the involved stakeholders in the design process, using 3 key questions for personalization. The framework focuses on the transferability of knowledge and reusability of personalization algorithms to simplify the design process of personalized serious games. UR - https://games.jmir.org/2023/1/e40054 UR - http://dx.doi.org/10.2196/40054 UR - http://www.ncbi.nlm.nih.gov/pubmed/36877554 ID - info:doi/10.2196/40054 ER - TY - JOUR AU - Jung, Myeongul AU - Sim, Sangyong AU - Kim, Jejoong AU - Kim, Kwanguk PY - 2022/11/8 TI - Impact of Personalized Avatars and Motion Synchrony on Embodiment and Users? Subjective Experience: Empirical Study JO - JMIR Serious Games SP - e40119 VL - 10 IS - 4 KW - embodiment KW - virtual reality KW - virtual avatar KW - personalization KW - personalized KW - body motion KW - presence KW - simulator sickness KW - simulator KW - simulation KW - avatar KW - motion KW - body ownership KW - self location KW - agency KW - experience KW - virtual world KW - immersive N2 - Background: Embodiment through a virtual avatar is a key element for people to feel that they are in the virtual world. Objective: This study aimed to elucidate the interaction between 2 methods of eliciting embodiment through a virtual avatar: motion synchronization and appearance similarity between a human and avatar, to understand embodiment (agency, body ownership, and self-location) and subjective experience (presence, simulator sickness, and emotion) in virtual reality. Methods: Using a full-body motion capture system, 24 participants experienced their virtual avatars with a 3D-scanned face and size-matched body from a first-person perspective. This study used a 2 (motion; sync and async) × 2 (appearance; personalized and generic) within-subject design. Results: The results indicated that agency and body ownership increased when motion and appearance were matched, whereas self-location, presence, and emotion were affected by motion only. Interestingly, if the avatar?s appearance was similar to the participants (personalized avatar), they formed an agency toward the avatar?s motion that was not performed by themselves. Conclusions: Our findings would be applicable in the field of behavioral therapy, rehabilitation, and entertainment applications, by eliciting higher agency with a personalized avatar. UR - https://games.jmir.org/2022/4/e40119 UR - http://dx.doi.org/10.2196/40119 UR - http://www.ncbi.nlm.nih.gov/pubmed/36346658 ID - info:doi/10.2196/40119 ER - TY - JOUR AU - Park, Sungjin AU - Kim, Sangkyun PY - 2022/9/29 TI - Points and the Delivery of Gameful Experiences in a Gamified Environment: Framework Development and Case Analysis JO - JMIR Serious Games SP - e35907 VL - 10 IS - 3 KW - point KW - design framework KW - gamification KW - gameful experience KW - pointsification KW - overjustification effect N2 - Background: Points represent one of the most widely used game mechanics in gamification. They have been used as a means to provide feedback to users. They visually show user performance and are used along with other game mechanics to produce synergy effects. However, using points without analyzing the application environment and targets adversely affects users. Objective: This study aims to identify the problems that users encounter when points are applied improperly, to solve problems based on an analysis of previous studies and actual point use cases, and to develop a point design framework to deliver gameful experiences. Methods: Three problems were identified by analyzing previous studies. The first problem is points that only accumulate. The second is points that emphasize a user?s difference from other people. The third pertains to the reward distribution problem that occurs when points are used as rewards. Results: We developed a framework by deriving 3 criteria for applying points. The first criterion is based on the passive acquisition approach and the active use approach. The second criterion is used to classify points as ?high/low? and ?many/few? types. The third criterion is the classification of personal reward points and group reward points based on segmentation of the reward criteria. We developed 8 types of points based on the derived point design framework. Conclusions: We expect that some of the problems that users experience when using points can be solved. Furthermore, we expect that some of the problems that arise when points are used as rewards, such as pointsification and the overjustification effect, can be solved. By solving such problems, we suggest a direction that enables a gameful experience for point users and improves the core value delivery through gameful experiences. We also suggest a gameful experience delivery method in the context of the ongoing COVID-19 pandemic. UR - https://games.jmir.org/2022/3/e35907 UR - http://dx.doi.org/10.2196/35907 UR - http://www.ncbi.nlm.nih.gov/pubmed/36173674 ID - info:doi/10.2196/35907 ER - TY - JOUR AU - Videnovik, Maja AU - Vold, Tone AU - Dimova, Georgina AU - Kiønig, Vibeke Linda AU - Trajkovik, Vladimir PY - 2022/9/26 TI - Migration of an Escape Room?Style Educational Game to an Online Environment: Design Thinking Methodology JO - JMIR Serious Games SP - e32095 VL - 10 IS - 3 KW - digital games KW - escape room KW - computational thinking KW - gamification KW - students? engagement KW - interactive learning environments KW - serious games KW - digital health KW - education KW - student education KW - learning outcomes KW - digital learning KW - digital education KW - educational games N2 - Background: The COVID-19 pandemic outbreak has led to a sudden change in education, closing schools and shifting to online teaching, which has become an enormous challenge for teachers and students. Implementing adequate online pedagogical approaches and integrating different digital tools in the teaching process have become a priority in educational systems. Finding a way to keep students' interest and persistence in learning is an important issue that online education is facing. One possible way to establish engaging and interactive learning environments, using the energy and enthusiasm of students for educational purposes, is the use of game-based learning activities and gamification of different parts of the educational process. Objective: This paper presents a use case of migrating an escape room?style educational game to an online environment by using the design thinking methodology. We wanted to show that the design thinking methodology is useful to create engaging and motivating online games that provide educational value. Methods: Starting from students? perspective, we created a simple digital escape room?style game where students got an opportunity to self-assess their knowledge in computer science at their own pace. Students tested this prototype game, and their opinions about the game were collected through an online survey. The test's goal was to evaluate the students' perceptions about the implemented digital escape room?style educational game and gather information about whether it could achieve students' engagement in learning computer science during online teaching. Results: In total, 117 students from sixth and seventh grades completed the survey regarding the achieved student engagement. Despite the differences in students? answers about game complexity and puzzle difficulty, most students liked the activity (mean 4.75, SD 0.67, on a scale from 1 to 5). They enjoyed the game, and they would like to participate in this kind of activity again (mean 4.74, SD 0.68). All (n=117, 100%) students found the digital escape room?style educational game interesting for playing and learning. Conclusions: The results confirmed that digital escape room?style games could be used as an educational tool to engage students in the learning process and achieve learning outcomes. Furthermore, the design thinking methodology proved to be a useful tool in the process of adding novel educational value to the digital escape room?style game. UR - https://games.jmir.org/2022/3/e32095 UR - http://dx.doi.org/10.2196/32095 UR - http://www.ncbi.nlm.nih.gov/pubmed/36155979 ID - info:doi/10.2196/32095 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 - Van Gaalen, J. A. E. AU - Schönrock-Adema, J. AU - Renken, J. R. AU - Jaarsma, C. A. D. AU - Georgiadis, R. J. PY - 2022/4/4 TI - Identifying Player Types to Tailor Game-Based Learning Design to Learners: Cross-sectional Survey using Q Methodology JO - JMIR Serious Games SP - e30464 VL - 10 IS - 2 KW - gamification KW - serious games KW - game-based learning KW - medical education KW - computers KW - new technology KW - focus group KW - play KW - qualitative KW - player types KW - taxonomy KW - theory KW - framework N2 - Background: Game-based learning appears to be a promising instructional method because of its engaging properties and positive effects on motivation and learning. There are numerous options to design game-based learning; however, there is little data-informed knowledge to guide the choice of the most effective game-based learning design for a given educational context. The effectiveness of game-based learning appears to be dependent on the degree to which players like the game. Hence, individual differences in game preferences should be taken into account when selecting a specific game-based learning design. Objective: We aimed to identify patterns in students? perceptions of play and games?player types and their most important characteristics. Methods: We used Q methodology to identify patterns in opinions on game preferences. We recruited undergraduate medical and dental students to participate in our study and asked participants to sort and rank 49 statements on game preferences. These statements were derived from a prior focus group study and literature on game preferences. We used by-person factor analysis and varimax rotation to identify common viewpoints. Both factors and participants? comments were used to interpret and describe patterns in game preferences. Results: From participants? (n=102) responses, we identified 5 distinct patterns in game preferences: the social achiever, the explorer, the socializer, the competitor, and the troll. These patterns revolved around 2 salient themes: sociability and achievement. The 5 patterns differed regarding cheating, playing alone, story-telling, and the complexity of winning. Conclusions: The patterns were clearly interpretable, distinct, and showed that medical and dental students ranged widely in how they perceive play. Such patterns may suggest that it is important to take students? game preferences into account when designing game-based learning and demonstrate that not every game-based learning-strategy fits all students. To the best of our knowledge, this study is the first to use a scientifically sound approach to identify player types. This can help future researchers and educators select effective game-based learning game elements purposefully and in a student-centered way. UR - https://games.jmir.org/2022/2/e30464 UR - http://dx.doi.org/10.2196/30464 UR - http://www.ncbi.nlm.nih.gov/pubmed/35377333 ID - info:doi/10.2196/30464 ER - TY - JOUR AU - Egashira, Mahiro AU - Son, Daisuke AU - Ema, Arisa PY - 2022/2/21 TI - Serious Game for Change in Behavioral Intention Toward Lifestyle-Related Diseases: Experimental Study With Structural Equation Modeling Using the Theory of Planned Behavior JO - JMIR Serious Games SP - e28982 VL - 10 IS - 1 KW - lifestyle-related disease KW - mechanism of behavior change KW - serious game KW - theory of planned behavior N2 - Background: Health activities should be tailored to individual lifestyles and values. To raise awareness of health behaviors, various practices related to health education, such as interactive activities among individuals with different backgrounds, have been developed. Moreover, serious games have been used as a tool for facilitating communication. However, there have been few investigations that are based on the framework of the theory of planned behavior on the mechanisms of health-related behavioral intention change from playing serious games. Objective: We aimed to investigate the mechanisms of behavioral intention change among various age groups after an intervention using a serious game to increase awareness of lifestyle-related diseases. Methods: Adults, undergraduates, and high school students played a serious game, called Negotiation Battle, and answered a questionnaire?Gaming Event Assessment Form for Lifestyle-related Diseases?before, immediately after, and 2-4 weeks after the game. The questionnaire was composed of 16 items based on the theory of planned behavior. We used structural equation modeling to compare responses from the 3 groups. Results: For all 3 age groups (adults: mean 43.4 years, range 23-67 years; undergraduates: mean 20.9 years, range 19-34 years; high school students: mean 17.9 years, 17-18 years), perceived behavior control was the key factor of behavioral intention change. Immediately after the game, causal relationships between perceived behavioral control and behavioral intention were enhanced or maintained for all groups?adults (before: path coefficient 1.030, P<.001; after: path coefficient 2.045, P=.01), undergraduates (before: path coefficient 0.568, P=.004; after: path coefficient 0.737, P=.001), and high school students (before: path coefficient 14.543, P=.97; after: path coefficient 0.791, P<.001). Analysis of free descriptions after intervention suggested that experiencing dilemma is related to learning and behavioral intention. Conclusions: The study revealed that the serious game changed the behavioral intention of adolescents and adults regarding lifestyle-related diseases, and changes in perceived behavioral control mediated the alteration mechanism. UR - https://games.jmir.org/2022/1/e28982 UR - http://dx.doi.org/10.2196/28982 UR - http://www.ncbi.nlm.nih.gov/pubmed/35188465 ID - info:doi/10.2196/28982 ER - TY - JOUR AU - Keith, J. Mark AU - Dean, L. Douglas AU - Gaskin, James AU - Anderson, Greg PY - 2021/12/14 TI - Team Building Through Team Video Games: Randomized Controlled Trial JO - JMIR Serious Games SP - e28896 VL - 9 IS - 4 KW - team video gaming KW - team building KW - flow KW - team cohesion KW - video games KW - gamification KW - team KW - teamwork KW - cohesion KW - theory KW - framework KW - performance N2 - Background: Organizations of all types require the use of teams. Poor team member engagement costs billions of US dollars annually. Objective: This study aimed to explain how team building can be accomplished with team video gaming based on a team cohesion model enhanced by team flow theory. Methods: In this controlled experiment, teams were randomly assigned to a team video gaming treatment or a control treatment. Team productivity was measured during both pretreatment and posttreatment team tasks. After the pretest, teams who were involved in the team video gaming treatment competed against other teams by playing the Halo or Rock Band video game for 45 minutes. After the pretest, teams in the control treatment worked alone for 45 minutes. Then, all teams completed the posttest team activity. This same experimental protocol was conducted on 2 different team tasks. Results: For both tasks, teams in the team video gaming treatment increased their productivity significantly more (F1=8.760, P=.004) on the posttest task than teams in the control treatment. Our flow-based theoretical model explained team performance improvement more than twice as well (R2=40.6%) than prior related research (R2=18.5%). Conclusions: The focused immersion caused by team video gaming increased team performance while the enjoyment component of flow decreased team performance on the posttest. Both flow and team cohesion contributed to team performance, with flow contributing more than cohesion. Team video gaming did not increase team cohesion, so team video gaming effects are independent of cohesion. Team video gaming is a valid practical method for developing and improving newly formed teams. UR - https://games.jmir.org/2021/4/e28896 UR - http://dx.doi.org/10.2196/28896 UR - http://www.ncbi.nlm.nih.gov/pubmed/34904954 ID - info:doi/10.2196/28896 ER - TY - JOUR AU - Robertson, C. Michael AU - Baranowski, Tom AU - Thompson, Debbe AU - Basen-Engquist, M. Karen AU - Swartz, Chang Maria AU - Lyons, J. Elizabeth PY - 2021/12/3 TI - Using the Behaviour Change Wheel Program Planning Model to Design Games for Health: Development Study JO - JMIR Serious Games SP - e29964 VL - 9 IS - 4 KW - physical activity KW - video games KW - eHealth KW - intervention KW - behavior and behavior mechanisms KW - psychological theory KW - serious games KW - gamification KW - older women KW - older adults KW - behavior change KW - behavioral interventions KW - mobile phone N2 - Background: Games for health are a promising approach to health promotion. Their success depends on achieving both experiential (game) and instrumental (health) objectives. There is little to guide game for health (G4H) designers in integrating the science of behavior change with the art of game design. Objective: The aim of this study is to extend the Behaviour Change Wheel program planning model to develop Challenges for Healthy Aging: Leveraging Limits for Engaging Networked Game-Based Exercise (CHALLENGE), a G4H centered on increasing physical activity in insufficiently active older women. Methods: We present and apply the G4H Mechanics, Experiences, and Change (MECHA) process, which supplements the Behaviour Change Wheel program planning model. The additional steps are centered on identifying target G4H player experiences and corresponding game mechanics to help game designers integrate design elements and G4H objectives into behavioral interventions. Results: We identified a target behavior of increasing moderate-intensity walking among insufficiently active older women and key psychosocial determinants of this behavior from self-determination theory (eg, autonomy). We used MECHA to map these constructs to intervention functions (eg, persuasion) and G4H target player experiences (eg, captivation). Next, we identified behavior change techniques (eg, framing or reframing) and specific game mechanics (eg, transforming) to help realize intervention functions and elicit targeted player experiences. Conclusions: MECHA can help researchers map specific linkages between distal intervention objectives and more proximal game design mechanics in games for health. This can facilitate G4H program planning, evaluation, and clearer scientific communication. UR - https://games.jmir.org/2021/4/e29964 UR - http://dx.doi.org/10.2196/29964 UR - http://www.ncbi.nlm.nih.gov/pubmed/34870604 ID - info:doi/10.2196/29964 ER - TY - JOUR AU - Pawassar, Matthias Christian AU - Tiberius, Victor PY - 2021/12/1 TI - Virtual Reality in Health Care: Bibliometric Analysis JO - JMIR Serious Games SP - e32721 VL - 9 IS - 4 KW - virtual reality KW - healthcare KW - bibliometric analysis KW - literature review KW - citation analysis KW - VR KW - usability KW - review KW - health care N2 - Background: Research into the application of virtual reality technology in the health care sector has rapidly increased, resulting in a large body of research that is difficult to keep up with. Objective: We will provide an overview of the annual publication numbers in this field and the most productive and influential countries, journals, and authors, as well as the most used, most co-occurring, and most recent keywords. Methods: Based on a data set of 356 publications and 20,363 citations derived from Web of Science, we conducted a bibliometric analysis using BibExcel, HistCite, and VOSviewer. Results: The strongest growth in publications occurred in 2020, accounting for 29.49% of all publications so far. The most productive countries are the United States, the United Kingdom, and Spain; the most influential countries are the United States, Canada, and the United Kingdom. The most productive journals are the Journal of Medical Internet Research (JMIR), JMIR Serious Games, and the Games for Health Journal; the most influential journals are Patient Education and Counselling, Medical Education, and Quality of Life Research. The most productive authors are Riva, del Piccolo, and Schwebel; the most influential authors are Finset, del Piccolo, and Eide. The most frequently occurring keywords other than ?virtual? and ?reality? are ?training,? ?trial,? and ?patients.? The most relevant research themes are communication, education, and novel treatments; the most recent research trends are fitness and exergames. Conclusions: The analysis shows that the field has left its infant state and its specialization is advancing, with a clear focus on patient usability. UR - https://games.jmir.org/2021/4/e32721 UR - http://dx.doi.org/10.2196/32721 UR - http://www.ncbi.nlm.nih.gov/pubmed/34855606 ID - info:doi/10.2196/32721 ER - TY - JOUR AU - Siriaraya, Panote AU - Visch, Valentijn AU - Boffo, Marilisa AU - Spijkerman, Renske AU - Wiers, Reinout AU - Korrelboom, Kees AU - Hendriks, Vincent AU - Salemink, Elske AU - van Dooren, Marierose AU - Bas, Michael AU - Goossens, Richard PY - 2021/12/1 TI - Game Design in Mental Health Care: Case Study?Based Framework for Integrating Game Design Into Therapeutic Content JO - JMIR Serious Games SP - e27953 VL - 9 IS - 4 KW - design models KW - gamification KW - case studies KW - mental health KW - eHealth UR - https://games.jmir.org/2021/4/e27953 UR - http://dx.doi.org/10.2196/27953 UR - http://www.ncbi.nlm.nih.gov/pubmed/34855611 ID - info:doi/10.2196/27953 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-Treviño, 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 - Yu, Yanqiu AU - Mo, Kit-Han Phoenix AU - Zhang, Jianxin AU - Li, Jibin AU - Lau, Tak-Fai Joseph PY - 2021/10/27 TI - Impulsivity, Self-control, Interpersonal Influences, and Maladaptive Cognitions as Factors of Internet Gaming Disorder Among Adolescents in China: Cross-sectional Mediation Study JO - J Med Internet Res SP - e26810 VL - 23 IS - 10 KW - cognition KW - adolescent health KW - health risk behaviors KW - internet KW - self-control KW - China N2 - Background: Gaming disorder, including internet gaming disorder (IGD), was recently defined by the World Health Organization as a mental disease in the 11th Revision of the International Classification of Diseases (ICD-11). Thus, reducing IGD is warranted. Maladaptive cognitions related to internet gaming (MCIG) have been associated with IGD, while impulsivity, self-control, parental influences, and peer influences are key risk factors of IGD. Previous literature suggests that MCIG is associated with the aforementioned 4 risk factors and IGD, and may thus mediate between these risk factors and IGD. These potential mediations, if significant, imply that modification of MCIG may possibly alleviate these risk factors? harmful impacts on increasing IGD. These mediation hypotheses were tested in this study for the first time. Objective: This study tested the mediation effects of MCIG between intrapersonal factors (impulsivity and self-control) and IGD, and between interpersonal factors (parental influences and peer influences) and IGD among adolescents in China. Methods: An anonymous, cross-sectional, and self-administered survey was conducted among secondary school students in classroom settings in Guangzhou and Chengdu, China. All grade 7 to 9 students (7 to 9 years of formal education) of 7 secondary schools were invited to join the study, and 3087 completed the survey. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) checklist was used to assess IGD. MCIG was assessed by using the Chinese version of the Revised Internet Gaming Cognition Scale. Impulsivity, self-control, and parental or peer influences were measured by using the motor subscale of the Barratt Impulsiveness Scale, the Brief Self-Control Scale, and the modified interpersonal influence scale, respectively. Structural equation modeling was conducted to examine the mediation effects of MCIG between these risk factors and IGD. Results: The prevalence of IGD was 13.57% (418/3081) and 17.67% (366/2071) among all participants and adolescent internet gamers, respectively. The 3 types of MCIG (perceived rewards of internet gaming, perceived urges for playing internet games, and perceived unwillingness to stop playing without completion of gaming tasks) were positively associated with IGD. Impulsivity, self-control, parental influences, and peer influences were all significantly associated with the 3 types of MCIG and IGD. The 3 types of MCIG partially mediated the associations between the studied factors and IGD (effect size of 30.0% to 37.8%). Conclusions: Impulsivity, self-control, and interpersonal influences had both direct and indirect effects via MCIG on IGD. Modifications of the 3 types of MCIG can potentially reduce the harmful impacts of impulsivity and interpersonal influences on IGD and enhance the protective effect of self-control against IGD. Future longitudinal studies are warranted. UR - https://www.jmir.org/2021/10/e26810 UR - http://dx.doi.org/10.2196/26810 UR - http://www.ncbi.nlm.nih.gov/pubmed/34704960 ID - info:doi/10.2196/26810 ER - TY - JOUR AU - Warsinsky, Simon AU - Schmidt-Kraepelin, Manuel AU - Rank, Sascha AU - Thiebes, Scott AU - Sunyaev, Ali PY - 2021/9/10 TI - Conceptual Ambiguity Surrounding Gamification and Serious Games in Health Care: Literature Review and Development of Game-Based Intervention Reporting Guidelines (GAMING) JO - J Med Internet Res SP - e30390 VL - 23 IS - 9 KW - game-based interventions KW - gamification KW - serious games KW - literature review KW - reporting guidelines KW - conceptual ambiguity N2 - Background: In health care, the use of game-based interventions to increase motivation, engagement, and overall sustainability of health behaviors is steadily becoming more common. The most prevalent types of game-based interventions in health care research are gamification and serious games. Various researchers have discussed substantial conceptual differences between these 2 concepts, supported by empirical studies showing differences in the effects on specific health behaviors. However, researchers also frequently report cases in which terms related to these 2 concepts are used ambiguously or even interchangeably. It remains unclear to what extent existing health care research explicitly distinguishes between gamification and serious games and whether it draws on existing conceptual considerations to do so. Objective: This study aims to address this lack of knowledge by capturing the current state of conceptualizations of gamification and serious games in health care research. Furthermore, we aim to provide tools for researchers to disambiguate the reporting of game-based interventions. Methods: We used a 2-step research approach. First, we conducted a systematic literature review of 206 studies, published in the Journal of Medical Internet Research and its sister journals, containing terms related to gamification, serious games, or both. We analyzed their conceptualizations of gamification and serious games, as well as the distinctions between the two concepts. Second, based on the literature review findings, we developed a set of guidelines for researchers reporting on game-based interventions and evaluated them with a group of 9 experts from the field. Results: Our results show that less than half of the concept mentions are accompanied by an explicit definition. To distinguish between the 2 concepts, we identified four common approaches: implicit distinction, synonymous use of terms, serious games as a type of gamified system, and distinction based on the full game dimension. Our Game-Based Intervention Reporting Guidelines (GAMING) consist of 25 items grouped into four topics: conceptual focus, contribution, mindfulness about related concepts, and individual concept definitions. Conclusions: Conceptualizations of gamification and serious games in health care literature are strongly heterogeneous, leading to conceptual ambiguity. Following the GAMING can support authors in rigorous reporting on study results of game-based interventions. UR - https://www.jmir.org/2021/9/e30390 UR - http://dx.doi.org/10.2196/30390 UR - http://www.ncbi.nlm.nih.gov/pubmed/34505840 ID - info:doi/10.2196/30390 ER - TY - JOUR AU - Wang, Tong AU - Fan, Lingye AU - Zheng, Xu AU - Wang, Wei AU - Liang, Jun AU - An, Kai AU - Ju, Mei AU - Lei, Jianbo PY - 2021/8/12 TI - The Impact of Gamification-Induced Users' Feelings on the Continued Use of mHealth Apps: A Structural Equation Model With the Self-Determination Theory Approach JO - J Med Internet Res SP - e24546 VL - 23 IS - 8 KW - mHealth app KW - continued use KW - continuance intention KW - gamification KW - self-determination theory (SDT) KW - expectation confirmation model of information system continuance (ECM-ISC) KW - PLS-SEM N2 - Background: Continued use of mHealth apps can achieve better effects in health management. Gamification is an important factor in promoting users? intention to continue using mHealth apps. Past research has rarely explored the factors underlying the continued use of mobile health (mHealth) apps and gamification?s impact mechanism or path on continued use. Objective: This study aimed to explore the factors influencing mHealth app users? intention to continue using mHealth apps and the impact mechanism and path of users? feelings induced by gamification on continued mHealth app use. Methods: First, based on the expectation confirmation model of information system continuance, we built a theoretical model for continued use of mHealth apps based on users? feelings toward gamification. We used self-determination theory to analyze gamification?s impact on user perceptions and set the resulting feelings (competence, autonomy, and relatedness) as constructs in the model. Second, we used the survey method to validate the research model, and we used partial least squares to analyze the data. Results: A total of 2988 responses were collected from mHealth app users, and 307 responses were included in the structural equation model after passing the acceptance criteria. The intrinsic motivation for using mHealth apps is significantly affected by autonomy (?=.312; P<.001), competence (?=.346; P<.001), and relatedness (?=.165; P=.004) induced by gamification. The intrinsic motivation for using mHealth apps has a significant impact on satisfaction (?=.311, P<.001) and continuance intention (?=.142; P=.045); furthermore, satisfaction impacts continuance intention significantly (?=.415; P<.001). Confirmation has a significant impact on perceived usefulness (?=.859; P<.001) and satisfaction (?=.391; P<.001), and perceived usefulness has a significant impact on satisfaction (?=.269; P<.001) and continuance intention (?=.273; P=.001). The mediating effect analysis showed that in the impact path of the intrinsic motivation for using the mHealth apps on continuance intention, satisfaction plays a partial mediating role (?=.129; P<.001), with a variance accounted for of 0.466. Conclusions: This study explored the impact path of users? feelings induced by gamification on the intention of continued mHealth app use. We confirmed that perceived usefulness, confirmation, and satisfaction in the classical continued use theory for nonmedical information systems positively affect continuance intention. We also found that the path and mechanism of users' feelings regarding autonomy, competence, and relatedness generated during interactions with different gamification elements promote the continued use of mHealth apps. UR - https://www.jmir.org/2021/8/e24546 UR - http://dx.doi.org/10.2196/24546 UR - http://www.ncbi.nlm.nih.gov/pubmed/34387550 ID - info:doi/10.2196/24546 ER - TY - JOUR AU - Choi, Eunhye AU - Shin, Suk-Ho AU - Ryu, Jeh-Kwang AU - Jung, Kyu-In AU - Hyun, Yerin AU - Kim, Jiyea AU - Park, Min-Hyeon PY - 2021/7/9 TI - Association of Extensive Video Gaming and Cognitive Function Changes in Brain-Imaging Studies of Pro Gamers and Individuals With Gaming Disorder: Systematic Literature Review JO - JMIR Serious Games SP - e25793 VL - 9 IS - 3 KW - brain imaging KW - cognitive function KW - gaming disorder KW - pro gamers KW - video games KW - cognition KW - brain KW - games KW - gaming N2 - Background: The World Health Organization announced the inclusion of gaming disorder (GD) in the International Classification of Diseases, 11th Revision, despite some concerns. However, video gaming has been associated with the enhancement of cognitive function. Moreover, despite comparable extensive video gaming, pro gamers have not shown any of the negative symptoms that individuals with GD have reported. It is important to understand the association between extensive video gaming and alterations in brain regions more objectively. Objective: This study aimed to systematically explore the association between extensive video gaming and changes in cognitive function by focusing on pro gamers and individuals with GD. Methods: Studies about pro gamers and individuals with GD were searched for in the PubMed and Web of Science databases using relevant search terms, for example, ?pro-gamers? and ?(Internet) gaming disorder.? While studies for pro gamers were searched for without date restrictions, only studies published since 2013 about individuals with GD were included in search results. Article selection was conducted by following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Results: By following the PRISMA guidelines, 1903 records with unique titles were identified. Through the screening process of titles and abstracts, 86 full-text articles were accessed to determine their eligibility. A total of 18 studies were included in this systematic review. Among the included 18 studies, six studies included pro gamers as participants, one study included both pro gamers and individuals with GD, and 11 studies included individuals with GD. Pro gamers showed structural and functional alterations in brain regions (eg, the left cingulate cortex, the insula subregions, and the prefrontal regions). Cognitive function (eg, attention and sensorimotor function) and cognitive control improved in pro gamers. Individuals with GD showed structural and functional alterations in brain regions (eg, the striatum, the orbitofrontal cortex, and the amygdala) that were associated with impaired cognitive control and higher levels of craving video game playing. They also showed increased cortical thickness in the middle temporal cortex, which indicated the acquisition of better skills. Moreover, it was suggested that various factors (eg, gaming expertise, duration or severity of GD, and level of self-control) seemed to modulate the association of extensive video game playing with changes in cognitive function. Conclusions: Although a limited number of studies were identified that included pro gamers and/or individuals who reported showing symptoms of GD for more than 1 year, this review contributed to the objective understanding of the association between extensive video game playing and changes in cognitive function. Conducting studies with a longitudinal design or with various comparison groups in the future would be helpful in deepening the understanding of this association. UR - https://games.jmir.org/2021/3/e25793 UR - http://dx.doi.org/10.2196/25793 UR - http://www.ncbi.nlm.nih.gov/pubmed/34255648 ID - info:doi/10.2196/25793 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-Treviño, 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 - 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 - Khaleghi, Ali AU - Aghaei, Zahra AU - Mahdavi, Amin Mohammad PY - 2021/5/18 TI - A Gamification Framework for Cognitive Assessment and Cognitive Training: Qualitative Study JO - JMIR Serious Games SP - e21900 VL - 9 IS - 2 KW - cognitive tasks KW - boredom KW - motivation KW - gamification KW - game elements KW - framework KW - process KW - gamification design KW - cognitive training KW - cognitive assessment N2 - Background: Cognitive tasks designed to measure or train cognition are often repetitive and presented in a monotonous manner, features that lead to participant boredom and disengagement. In this situation, participants do not put forth their best effort to do these tasks well. As a result, neuropsychologists cannot draw accurate conclusions about the data collected, and intervention effects are reduced. It is assumed that greater engagement and motivation will manifest as improved data quality. Gamification, the use of game elements in nongame settings, has been heralded as a potential mechanism for increasing participant engagement in cognitive tasks. Some studies have reported a positive effect of gamification on participant performance, although most studies have shown mixed results. One reason for these contrasting findings is that most studies have applied poor and heterogeneous design techniques to gamify cognitive tasks. Therefore, an appropriate gamification design framework is needed in these tasks. Objective: This study aimed to propose a framework to guide the design of gamification in cognitive tasks. Methods: We employed a design science research (DSR) approach to provide a framework for gamifying cognitive assessments and training by synthesizing current gamification design frameworks and gamification works in cognitive assessment and training, as well as incorporating field experiences. The prototypes of the framework were iteratively evaluated with 17 relevant experts. Results: We proposed a framework consisting of 7 phases: (1) preparation; (2) knowing users; (3) exploring existing tools for assessing or training a targeted cognitive context and determining the suitability of game-up and mapping techniques; (4) ideation; (5) prototyping using the Objects, Mechanics, Dynamics, Emotions (OMDE) design guideline; (6) development; and (7) disseminating and monitoring. Conclusions: We found that (1) an intermediate design framework is needed to gamify cognitive tasks, which means that game elements should be selected by considering current cognitive assessment or training context characteristics since game elements may impose an irrelevant cognitive load that, in turn, can jeopardize data quality; (2) in addition to developing a new gamified cognitive task from scratch, 2 gamification techniques are widely used (first, adding game elements to an existing cognitive task and second, mapping an existing game to a cognitive function or impairment to assess or train it); and (3) further research is required to investigate the interplay of cognitive processes and game mechanics. UR - https://games.jmir.org/2021/2/e21900 UR - http://dx.doi.org/10.2196/21900 UR - http://www.ncbi.nlm.nih.gov/pubmed/33819164 ID - info:doi/10.2196/21900 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 - Bányai, Fanni AU - Zsila, Ágnes AU - Kökönyei, Gyöngyi AU - Griffiths, D. Mark AU - Demetrovics, Zsolt AU - Király, Orsolya PY - 2021/3/23 TI - The Moderating Role of Coping Mechanisms and Being an e-Sport Player Between Psychiatric Symptoms and Gaming Disorder: Online Survey JO - JMIR Ment Health SP - e21115 VL - 8 IS - 3 KW - gaming disorder KW - esports KW - professional gaming KW - video games KW - coping skills KW - psychiatric symptoms KW - psychiatry KW - mental health KW - gaming N2 - Background: The emerging popularity of playing video games (gaming) as a hobby and as a professional sport raises awareness about both the benefits and possible downsides of the activity. Although a healthy and passionate hobby for most, a minority of gamers experience addiction-like symptoms and are considered to have gaming disorder (GD). GD has previously been found to be related to aversive conditions, such as depression or anxiety, as well as putatively maladaptive coping strategies. Objective: The aim of this study is twofold: to explore the moderating effect of different coping strategies and type of video game usage (professional [e-sport] or recreational) on the relationship between psychiatric symptoms and GD. Methods: A sample of 3476 gamers (n=3133, 90.13% males; mean age 23.20, SD 6.48 years) was recruited via the website and social networking site of the most popular gaming magazine in Hungary (GameStar). Results: The main effect of psychiatric symptoms was moderate to large in all models, whereas the moderation effects were significant (P<.001) for 4 out of 8 coping strategies (ie, self-blame/self-distraction, denial, emotional/social support, and active coping). However, the explained variance of the models only increased negligibly (from 0.3% to 0.5%) owing to the moderation effect. The direction of the moderations was as expected (ie, putatively maladaptive strategies were associated with more GD symptoms when the level of psychiatric symptoms was high, while putatively adaptive strategies were associated with less). Furthermore, no considerable moderation effect of the player type (recreational vs professional players) was found on the association between psychiatric symptoms and GD (?=.04; P=.02; 0.1% change in the explained variance). Conclusions: Future studies should be designed to better understand coping-related mechanisms in the context of video gaming and GD. UR - https://mental.jmir.org/2021/3/e21115 UR - http://dx.doi.org/10.2196/21115 UR - http://www.ncbi.nlm.nih.gov/pubmed/33755024 ID - info:doi/10.2196/21115 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 - Bierbooms, A. Joyce J. P. AU - Sluis-Thiescheffer, W. Wouter R. J. AU - Feijt, A. Milou AU - IJsselsteijn, A. Wijnand AU - Bongers, B. Inge M. PY - 2021/2/17 TI - Design of a Game-Based Training Environment to Enhance Health Care Professionals? E?Mental Health Skills: Protocol for a User Requirements Analysis JO - JMIR Res Protoc SP - e18815 VL - 10 IS - 2 KW - mental health KW - skill development KW - eHealth KW - games KW - user-centered design N2 - Background: E?mental health (EMH) offers various possibilities for mental health care delivery, with many studies demonstrating its clinical efficacy. However, the uptake of EMH technologies by mental health care professionals remains to be low. One of the reasons for this is the lack of knowledge and skills in using these technologies. Skill enhancement by means of serious gaming has been shown to be effective in other areas but has not yet been applied to the development of EMH skills of mental health care professionals. Objective: The aim of this paper is to describe a study protocol for the user requirements analysis for the design of a game-based training environment for mental health care professionals to enhance their skills in EMH. Methods: The user requirements are formulated using three complementary outputs: personas (lively descriptions of potential users), scenarios (situations that require EMH skills), and prerequisites (required technical and organizational conditions). We collected the data using a questionnaire, co-design sessions, and interviews. The questionnaire was used to determine mental health care professionals? characteristics, attitudes, and skill levels regarding EMH and was distributed among mental health care professionals in the Netherlands. This led to a number of recognizable subuser groups as the basis for personas. Co-design sessions with mental health care professionals resulted in further specification of the personas and an identification of different user scenarios for the game-based training environment. Interviews with mental health care professionals helped to determine the preferences of mental health care professionals regarding training in EMH and the technical and organizational conditions required for the prospective game-based training environment to be used in practice. This combination of requirement elicitation methods allows for a good representation of the target population in terms of both a broad view of user needs (through the large N questionnaire) and an in-depth understanding of specific design requirements (through interviews and co-design). Results: The questionnaire was filled by 432 respondents; three co-design sessions with mental health care professionals and 17 interviews were conducted. The data have been analyzed, and a full paper on the results is expected to be submitted in the first half of 2021. Conclusions: To develop an environment that can effectively support professionals? EMH skill development, it is important to offer training possibilities that address the specific needs of mental health care professionals. The approach described in this protocol incorporates elements that enable the design of a playful training environment that is user driven and flexible and considers the technical and organizational prerequisites that influence its implementation in practice. It describes a protocol that is replicable and provides a methodology for user requirements analyses in other projects and health care areas. International Registered Report Identifier (IRRID): RR1-10.2196/18815 UR - http://www.researchprotocols.org/2021/2/e18815/ UR - http://dx.doi.org/10.2196/18815 UR - http://www.ncbi.nlm.nih.gov/pubmed/33595453 ID - info:doi/10.2196/18815 ER - TY - JOUR AU - Schmidt-Kraepelin, Manuel AU - Toussaint, A. Philipp AU - Thiebes, Scott AU - Hamari, Juho AU - Sunyaev, Ali PY - 2020/10/19 TI - Archetypes of Gamification: Analysis of mHealth Apps JO - JMIR Mhealth Uhealth SP - e19280 VL - 8 IS - 10 KW - mHealth KW - smartphones KW - mobile phones KW - gamification KW - quantified-self KW - exergames, persuasive technology N2 - Background: Nowadays, numerous health-related mobile apps implement gamification in an attempt to draw on the motivational potential of video games and thereby increase user engagement or foster certain health behaviors. However, research on effective gamification is still in its infancy and researchers increasingly recognize methodological shortcomings of existing studies. What we actually know about the phenomenon today stems from fragmented pieces of knowledge, and a variety of different perspectives. Existing research primarily draws on conceptual knowledge that is gained from research prototypes, and isolated from industry best practices. We still lack knowledge on how gamification has been successfully designed and implemented within the industry and whether certain gamification approaches have shown to be particularly suitable for certain health behaviors. Objective: We address this lack of knowledge concerning best practices in the design and implementation of gamification for health-related mobile apps by identifying archetypes of gamification approaches that have emerged in pertinent health-related mobile apps and analyzing to what extent those gamification approaches are influenced by the underlying desired health-related outcomes. Methods: A 3-step research approach is employed. As a first step, a database of 143 pertinent gamified health-related mobile apps from the Apple App Store and Google Play Store is set up. Second, the gamification approach of each app within the database is classified based on an established taxonomy for gamification in health-related apps. Finally, a 2-step cluster analysis is conducted in order to identify archetypes of the most dominant gamification approaches in pertinent gamified health-related mobile apps. Results: Eight archetypes of gamification emerged from the analysis of health-related mobile apps: (1) competition and collaboration, (2) pursuing self-set goals without rewards, (3) episodical compliance tracking, (4) inherent gamification for external goals, (5) internal rewards for self-set goals, (6) continuous assistance through positive reinforcement, (7) positive and negative reinforcement without rewards, and (8) progressive gamification for health professionals. The results indicate a close relationship between the identified archetypes and the actual health behavior that is being targeted. Conclusions: By unveiling salient best practices and discussing their relationship to targeted health behaviors, this study contributes to a more profound understanding of gamification in mobile health. The results can serve as a foundation for future research that advances the knowledge on how gamification may positively influence health behavior change and guide practitioners in the design and development of highly motivating and effective health-related mobile health apps. UR - https://mhealth.jmir.org/2020/10/e19280 UR - http://dx.doi.org/10.2196/19280 UR - http://www.ncbi.nlm.nih.gov/pubmed/33074155 ID - info:doi/10.2196/19280 ER - TY - JOUR AU - Weerdmeester, Joanneke AU - van Rooij, MJW Marieke AU - Engels, CME Rutger AU - Granic, Isabela PY - 2020/7/23 TI - An Integrative Model for the Effectiveness of Biofeedback Interventions for Anxiety Regulation: Viewpoint JO - J Med Internet Res SP - e14958 VL - 22 IS - 7 KW - biofeedback KW - neurofeedback KW - anxiety KW - appraisal KW - mechanisms KW - mental health KW - eHealth KW - video games KW - wearable technology KW - review KW - mobile phone UR - https://www.jmir.org/2020/7/e14958 UR - http://dx.doi.org/10.2196/14958 UR - http://www.ncbi.nlm.nih.gov/pubmed/32706654 ID - info:doi/10.2196/14958 ER - TY - JOUR AU - Tan, Wen Jun AU - Zary, Nabil PY - 2019/07/16 TI - Diagnostic Markers of User Experience, Play, and Learning for Digital Serious Games: A Conceptual Framework Study JO - JMIR Serious Games SP - e14620 VL - 7 IS - 3 KW - serious games KW - diagnostic criteria KW - medical education N2 - Background: Serious games for medical education have seen a resurgence in recent years, partly due to the growth of the video game industry and the ability of such games to support learning achievements. However, there is little consensus on what the serious and game components in a serious game are composed of. As a result, electronic learning (e-learning) and medical simulation modules are sometimes mislabeled as serious games. We hypothesize that one of the main reasons is the difficulty for a medical educator to systematically and accurately evaluate key aspects of serious games. Objective: This study aimed to identify markers that can evaluate serious games and distinguish between serious games, entertainment games, and e-learning. Methods: Jabareen?s eight-phase framework-building procedure was used to identify the core markers of a serious game. The procedure was modified slightly to elicit ?diagnostic criteria? as opposed to its original purpose of a conceptual framework. Following the identification of purported markers, the newly developed markers were tested on a series of freely available health care serious games?Dr. Game Surgeon Trouble, Staying Alive, and Touch Surgery?and the results were compared to the published test validity for each game. Results: Diagnostic criteria for serious games were created, comprising the clusters of User Experience (UX), Play, and Learning. Each cluster was formed from six base markers, a minimum of four of which were required for a cluster to be considered present. These criteria were tested on the three games, and Dr. Game Surgeon Trouble and Staying Alive fit the criteria to be considered a serious game. Touch Surgery did not meet the criteria, but fit the definition of an e-learning module. Conclusions: The diagnostic criteria appear to accurately distinguish between serious games and mediums commonly misidentified as serious games, such as e-learning modules. However, the diagnostic criteria do not determine if a serious game will be efficacious; they only determine if it is a serious game. Future research should include a much larger sample of games designed specifically for health care purposes. UR - http://games.jmir.org/2019/3/e14620/ UR - http://dx.doi.org/10.2196/14620 UR - http://www.ncbi.nlm.nih.gov/pubmed/31313660 ID - info:doi/10.2196/14620 ER - TY - JOUR AU - Khalili-Mahani, Najmeh AU - De Schutter, Bob PY - 2019/06/06 TI - Affective Game Planning for Health Applications: Quantitative Extension of Gerontoludic Design Based on the Appraisal Theory of Stress and Coping JO - JMIR Serious Games SP - e13303 VL - 7 IS - 2 KW - games KW - user acceptance of health care KW - psychology KW - informatics KW - aging KW - adaptation KW - rehabilitation UR - http://games.jmir.org/2019/2/e13303/ UR - http://dx.doi.org/10.2196/13303 UR - http://www.ncbi.nlm.nih.gov/pubmed/31172966 ID - info:doi/10.2196/13303 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 -