Sweet care against sugar bitterness, designing health-based electronic game

Health-based electronic games present an innovative tool to deal with mental and behavioral disorders as well as physical. An appropriately designed game can optimize health care. The aim of this study was to establish a design for health-based electronic games model and to develop a sample game in diabetes. This study was carried out in two phases: first, the design of a health-based electronic game framework and second, the design and production of sweet care game. There were two intended information prerequisites: determination of effective components in models of behavior change and validation of these components on health topics and structural formation of a game. The game framework design was presented. In the second phase, a sample of the game was developed in the field of diabetes. Important components to empower people were ranked using the Friedman test in the following order: self-learning, treatment, mental empowerment, condition management, healthy eating and physical activity. The axis of self-learning received the highest rating from the perspective of the subjects with an average of 3.93 percent. Another part was the game framework with components as follows: application areas, educational content for change behavior, resources, game structure and game production. Finally, the sweet care game was designed on diabetes with educational, technological and clinical content. The health-based electronic game designed on a systematic framework could be applied as a tool to expanding the knowledge base on how to create effective health-based digital games that entertain while promoting behavior change.

Board Games for Health: A Systematic Literature Review and Meta-Analysis

Nondigital board games are being used to engage players and impact outcomes in health and medicine across diverse populations and contexts. This systematic review and meta-analysis describes and summarizes their impact based on randomized and nonrandomized controlled trials. An electronic search resulted in a review of n = 21 eligible studies. Sample sizes ranged from n = 17 to n = 3110 (n = 6554 total participants). A majority of the board game interventions focused on education to increase health-related knowledge and behaviors (76%, n = 16). Outcomes evaluated included self-efficacy, attitudes/beliefs, biological health indicators, social functioning, anxiety, and executive functioning, in addition to knowledge and behaviors. Using the Cochrane Collaboration tool for assessing bias, most studies (52%, n = 11) had an unclear risk of bias (33% [n = 7] had a high risk and 14% [n = 3] had a low risk). Statistical tests of publication bias were not significant. A random-effects meta-analysis showed a large average effect of board games on health-related knowledge (d* = 0.82, 95% confidence interval; CI [0.15-1.48]), a small-to-moderate effect on behaviors (d* = 0.33, 95% CI [0.16-0.51]), and a small-to-moderate effect on biological health indicators (d* = 0.37, 95% CI [0.21-0.52]). The findings contribute to the literature on games and gamified approaches in healthcare. Future research efforts should aim for more consistent high scientific standards in their evaluation protocols and reporting methodologies to provide a stronger evidence base.

Video Games as a Potential Modality for Behavioral Health Services for Young Adult Veterans: Exploratory Analysis

BACKGROUND

Improving the reach of behavioral health services to young adult veterans is a policy priority.

OBJECTIVE

The objective of our study was to explore differences in video game playing by behavioral health need for young adult veterans to identify potential conditions for which video games could be used as a modality for behavioral health services.

METHODS

We replicated analyses from two cross-sectional, community-based surveys of young adult veterans in the United States and examined the differences in time spent playing video games by whether participants screened positive for behavioral health issues and received the required behavioral health services.

RESULTS

Pooling data across studies, participants with a positive mental health screen for depression or posttraumatic stress disorder (PTSD) spent 4.74 more hours per week (95% CI 2.54-6.94) playing video games. Among participants with a positive screen for a substance use disorder, those who had received substance use services since discharge spent 0.75 more days per week (95% CI 0.28-1.21) playing video games than participants who had not received any substance use services since discharge.

CONCLUSIONS

We identified the strongest evidence that participants with a positive PTSD or depression screen and participants with a positive screen for a substance use disorder who also received substance use services since their discharge from active duty spent more time playing video games. Future development and evaluation of video games as modalities for enhancing and increasing access to behavioral health services should be explored for this population.

The effects of a gamified approach avoidance training and verbal suggestions on food outcomes

There is initial support for the effectiveness of approach-avoidance trainings in altering food-related health behaviors. Furthermore, outcome expectancies induced by verbal suggestions might optimize the effectiveness of these interventions, as shown in placebo research. The present study investigated the effectiveness of a gamified approach-avoidance training on food-related outcomes and whether verbal suggestions could strengthen those effects. A total of 120 participants were randomly assigned to 1 of 4 conditions: serious gaming only, verbal suggestions only, serious gaming combined with verbal suggestions, or a gaming control condition. Virtual food preference and food choice were assessed with a food choice task, with pairs differing in healthiness or in healthiness and attractiveness. Implicit food preference was assessed with an Implicit Association Test and food intake with a bogus taste test. Participants in both serious gaming conditions made healthier food choices for pairs differing in healthiness and attractiveness and had healthier implicit food preferences compared to gaming control. No effects were found on food intake. These findings provide the first preliminary support for the effects of a gamified approach-avoidance training on virtual food choice and implicit food preference. Future studies should further elucidate these effects, also in other health domains such as physical activity.

Serious Games for Children with Chronic Diseases: A Systematic Review

OBJECTIVE

The purpose of this study was to systematically review the literature to assess if serious games impact health outcomes for children less than 18 years of age with chronic diseases. Additionally, the impact of self-efficacy, adherence, knowledge, use of theory, parent involvement, and study quality was also examined.

MATERIALS AND METHODS

Searches were conducted in databases EBSCO, PubMed, and Web of Science between June and August 2016. Randomized controlled trials using a serious game as an intervention, for participants under 18 years of age, to improve their chronic disease were included.

RESULTS

Data were extracted by two independent researchers, including: Title, author, and publication year; chronic disease; game description; number and age of participants; intervention duration; significant findings; parent involvement; theory; and study quality. Any disagreements were tackled and consensus was achieved. Eighteen studies were included in the review. The areas of health addressed included cerebral palsy, asthma, diabetes, developmental coordination disorders, and vision disorders. In these articles, eight health outcome variables were measured, including: lung function, glycemic control, hospital visits, motor proficiency, and visual acuity. Psychosocial variables that were assessed included self-efficacy and knowledge. Two articles included parents in the intervention, and three articles used theory. Six studies had significant health outcome finding, and four studies found a significant change in one psychosocial variable.

CONCLUSION

This review demonstrates the potential for games to improve health outcomes of young individuals. However, the mixed results suggest that more serious game interventions need to be better designed and rigorously tested to support their impact on improving health outcomes.

Efficacy of gamification-based smartphone application for weight loss in overweight and obese adolescents: study protocol for a phase II randomized controlled trial

BACKGROUND

Overweight and obesity are significant public health concerns that are prevalent in younger age cohorts. Preventive or therapeutic interventions are difficult to implement and maintain over time. On the other hand, the majority of adolescents in the United States have a smartphone, representing a huge potential for innovative digitized interventions, such as weight loss programs delivered via smartphone applications. Although the number of available smartphone applications is increasing, evidence for their effectiveness in weight loss is insufficient. Therefore, the proposed study aims to assess the efficacy of a gamification-based smartphone application for weight loss in overweight and obese adolescents. The trial is designed to be a phase II, single-centre, two-arm, triple-blinded, randomized controlled trial (RCT) with a duration of 6 months.

METHOD

The intervention consists of a smartphone application that provides both tracking and gamification elements, while the control arm consists of an identically designed application solely with tracking features of health information. The proposed trial will be conducted in an urban primary care clinic of an academic centre in the United States of America, with expertise in the management of overweight and obese adolescents. Eligible adolescents will be followed for 6 months. Changes in body mass index z score from baseline to 6 months will be the primary outcome. Secondary objectives will explore the effects of the gamification-based application on adherence, as well as anthropometric, metabolic and behavioural changes. A required sample size of 108 participants (54 participants per group) was calculated.

DISCUSSION

The benefits of the proposed study include mid-term effects in weight reduction for overweight and obese adolescents. The current proposal will contribute to fill a gap in the literature on the mid-term effects of gamification-based interventions to control weight in adolescents. This trial is a well-designed RCT that is in line with the Consolidated Standards of Reporting Trials statement.

Socially-driven persuasive health intervention design: Competition, social comparison, and cooperation

Persuasive technologies are tools for motivating behaviour change using persuasive strategies. socially-driven persuasive technologies employ three common socially-oriented persuasive strategies in many health domains: competition, social comparison, and cooperation. Research has shown the possibilities for socially-driven persuasive interventions to backfire by demotivating behaviour, but we lack knowledge about how the interventions could motivate or demotivate behaviours. To close this gap, we studied 1898 participants, specifically Socially-oriented strategies and their comparative effectiveness in socially-driven persuasive health interventions that motivate healthy behaviour change. The results of a thematic analysis of 278 pages of qualitative data reveal important strengths and weaknesses of the individual socially-oriented strategies that could facilitate or hinder their effectiveness at motivating behaviour change. These include their tendency to simplify behaviours and make them fun, challenge people and make them accountable, give a sense of accomplishment and their tendency to jeopardize user's privacy and relationships, creates unnecessary tension, and reduce self-confidence and self-esteem, and provoke a health disorder and body shaming, respectively. We contribute to the health informatics community by developing 15 design guidelines for operationalizing the strategies in persuasive health intervention to amplify their strengths and overcome their weaknesses.

A systematic review of game technologies for pediatric patients

Children in hospital are subjected to multiple negative stimuli that may hinder their development and social interactions. Although game technologies are thought to improve children's experience in hospital, there is a lack of information on how they can be used effectively. This paper presents a systematic review of the literature on the existing approaches in this context to identify gaps for future research. A total of 1305 studies were identified, of which 75 were thoroughly analyzed according to our review protocol. The results show that the most common approach is to design mono-user games with traditional computers or monitor-based video consoles, which serve as a distractor or a motivator for physical rehabilitation for primary school children undergoing fearful procedures such as venipuncture, or those suffering chronic, neurological, or traumatic diseases/injures. We conclude that, on the one hand, game technologies seem to present physical and psychological benefits to pediatric patients, but more research is needed on this. On the other hand, future designers of games for pediatric hospitalization should consider: 1. The development for kindergarten patients and adolescents, 2. Address the psychological impact caused by long-term hospitalization, 3. Use collaboration as an effective game strategy to reduce patient isolation, 4. Have purposes other than distraction, such as socialization, coping with emotions, or fostering physical mobility, 5. Include parents/caregivers and hospital staff in the game activities; and 6. Exploit new technological artifacts such as robots and tangible interactive elements to encourage intrinsic motivation.

Epic Allies, a Gamified Mobile Phone App to Improve Engagement in Care, Antiretroviral Uptake, and Adherence Among Young Men Who Have Sex With Men and Young Transgender Women Who Have Sex With Men: Protocol for a Randomized Controlled Trial

Background

In the United States, young men who have sex with men (YMSM) and transgender women who have sex with men (YTWSM) bear a disproportionate burden of prevalent and incident HIV infections. Once diagnosed, many YMSM and YTWSM struggle to engage in HIV care, adhere to antiretroviral therapy (ART), and achieve viral suppression. Computer-based interventions, including those focused on behavior change, are recognized as effective tools for engaging youth.

Objective

The purpose of the study described in this protocol is to evaluate the efficacy of Epic Allies, a theory-based mobile phone app that utilizes game mechanics and social networking features to improve engagement in HIV care, ART uptake, ART adherence, and viral suppression among HIV-positive YMSM and YTWSM. The study also qualitatively assesses intervention acceptability, perceived impact, and sustainability.

Methods

This is a two-group, active-control randomized controlled trial of the Epic Allies app. YMSM and YTWSM aged 16 to 24 inclusive, with detectable HIV viral load are randomized 1:1 within strata of new to care (newly entered HIV medical care ≤12 months of baseline visit) or ART-nonadherent (first entered HIV medical care >12 months before baseline visit) to intervention or control conditions. The intervention condition addresses ART adherence barriers through medication reminders and adherence monitoring, tracking of select adherence-related behaviors (eg, alcohol and marijuana use), an interactive dashboard that displays the participant’s adherence-related behaviors and provides tailored feedback, encouragement messages from other users, daily HIV/ART educational articles, and gamification features (eg, mini-games, points, badges) to increase motivation for behavior change and app engagement. The control condition features weekly phone-based notifications to encourage participants to view educational information in the control app. Follow-up assessments are administered at 13, 26, and 39 weeks for each arm. The primary outcome measure is viral suppression. Secondary outcome measures include engagement in care, ART uptake, ART adherence, and psychosocial barriers to engagement in care and ART adherence, including psychological distress, stigma, and social support.

Results

Baseline enrollment began in September 2015 and was completed in September 2016 (n=146), and assessment of intervention outcomes continued through August 2017. Results for primary and secondary outcome measures are expected to be reported in ClinicalTrials.gov by April 30, 2018.

Conclusions

If successful, Epic Allies will represent a novel adherence intervention for a group disproportionately impacted by HIV in the United States. Adherent patients would require less frequent clinic visits and experience fewer HIV-related secondary infections, thereby reducing health care costs and HIV transmission. Epic Allies could easily be expanded and adopted for use among larger populations of YMSM and YTWSM, other HIV-positive populations, and for those diagnosed with other chronic diseases such as diabetes and hypertension.

Trial Registration

ClinicalTrials.gov NCT02782130; https://clinicaltrials.gov/ct2/show/NCT02782130 (Archived by Webcite at http://www.webcitation.org/6yGODyerk)

A serious game for children with Attention Deficit Hyperactivity Disorder: Who benefits the most?

OBJECTIVE

The aim of the current study was to identify which subgroups of children with Attention Deficit Hyperactivity Disorder (ADHD) benefitted the most from playing a Serious Game (SG) intervention shown in a randomized trial to improve behavioral outcomes.

METHOD

Pre-intervention characteristics [i.e., gender, age, intellectual level of functioning, medication use, computer experience, ADHD subtype, severity of inattention problems, severity of hyperactivity/impulsivity problems, comorbid Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD) symptoms] were explored as potential moderators in a Virtual Twins (VT) analysis to identify subgroups for whom the SG intervention was most effective. Primary outcome measures were parent-reported time management, planning/organizing and cooperation skills.

RESULTS

Two subgroups were identified. Girls (n = 26) were identified as the subgroup that was most likely to show greater improvements in planning/organizing skills as compared to the estimated treatment effect of the total group of participants. Furthermore, among the boys, those (n = 47) with lower baseline levels of hyperactivity and higher levels of CD symptoms showed more improvements in their planning/organizing skills when they played the SG intervention as compared to the estimated treatment effect of the total group of participants.

CONCLUSION

Using a VT analysis two subgroups of children with ADHD, girls, and boys with both higher levels of CD and lower levels of hyperactivity, were identified. These subgroups mostly benefit from playing the SG intervention developed to improve ADHD related behavioral problems. Our results imply that these subgroups have a higher chance of treatment success.

Empirical Evidence for the Outcomes of Therapeutic Video Games for Adolescents With Anxiety Disorders: Systematic Review

Background

Extant evidence suggests that the proportion of adolescents suffering from anxiety disorders (ADs) has increased by up to 70% since the mid-1980s, with experience of anxiety at this stage associated with significant negative short- and long-term life outcomes. The existing therapeutic interventions (eg, cognitive behavioral therapy, CBT; attention bias modification, ABM) have proven to have clinically measurable benefits in reducing anxiety, but their efficacy is often compromised by social and practical barriers. The growing discrepancy between demand for, and access to, clinical interventions for anxiety has led to the development of a range of eHealth (health care practice supported by electronic processes and communication) and mHealth (versions of eHealth using mobile devices) interventions. One such protocol is therapeutic games, which aim to provide clinical frameworks in dynamic, adaptable, and personalized virtual environments. Although some evidence exists to suggest therapeutic games are associated with reductions in subjective anxiety and observed stress reactivity, there is currently, to our knowledge, no systematic review of the adherence to, and effectiveness of, therapeutic games for adolescent anxiety.

Objective

The aim of this review was to establish the effectiveness of therapeutic games in making clinically measurable reductions in anxiety symptoms in adolescent samples.

Methods

A systematic search of the existing academic literature published between 1990 and July 2017 was conducted using the databases Journal of Medical Internet Research, Journal Storage, Psychology Articles, Psychology Info, ScienceDIRECT, and Scopus. Records linked to empirical papers on therapeutic games for anxiety using adolescent samples were evaluated.

Results

A total of 5 studies (N=410 participants) met the inclusion criteria, and 3 gamified anxiety interventions for adolescents were identified. The papers included a mixture of randomized controlled trials, quasi-experimental studies, and usability studies comprising quantitative and qualitative measures, with varying degrees of mixed methods. Extant evidence shows potential for therapeutic games to create clinically measurable reductions in symptoms of anxiety in adolescent samples, though findings are complicated in some cases by a low sample size, and in other cases by research design and methodological complications, including anxiety reductions in control groups caused by a control-game selection.

Conclusions

Although research in this field appears to be extremely limited, as demonstrated by the small number of papers meeting the inclusion criteria for this review, early findings suggest that therapeutic games have potential in helping to engage adolescents with anxiety and lead to clinically measurable reductions in symptoms.

A State-of-the-Art Systematic Content Analysis of Games for Health

As the field of games for health continues to gain momentum, it is crucial to document the field's scale of growth, identify design patterns, and to address potential design issues for future health game development. Few studies have explored the attributes and usability features of games for health as a whole over time. We offer the first comprehensive systematic content analysis of digital games for health by examining 1743 health games released between 1983 and 2016 in 23 countries extracted from nine international English health game databases and directories. The majority of these games were developed in the United States (67.18%) and France (18.59%). The most popular platforms included web browsers (72.38%) and Windows (14.41%). Approximately four out of five (79.12%) of the games were available at no cost. We coded 1553 accessible games for an in-depth analysis and further assessed 1303 for usability. Popular health topics represented included: cognitive training (37.41%), indirect health education (13.33%), and medical care provision (9.98%). Most games (75.66%) could be completed within 60 minutes. The main game usability problems identified included a lack of customization, nonskippable contents, and a lack of feedback and instruction to the players. While most of the usability problems have improved as did the software and hardware technology, the players' ability to skip nonplayable contents has become slightly more restricted overtime. Comparison with game efficacy publications suggested that a further understanding of the scope for games for health is needed on a global level.

Design and Evaluation of a Pervasive Coaching and Gamification Platform for Young Diabetes Patients

Self monitoring, personal goal-setting and coaching, education and social support are strategies to help patients with chronic conditions in their daily care. Various tools have been developed, e.g., mobile digital coaching systems connected with wearable sensors, serious games and patient web portals to personal health records, that aim to support patients with chronic conditions and their caregivers in realizing the ideal of self-management. We describe a platform that integrates these tools to support young patients in diabetes self-management through educational game playing, monitoring and motivational feedback. We describe the design of the platform referring to principles from healthcare, persuasive system design and serious game design. The virtual coach is a game guide that can also provide personalized feedback about the user's daily care related activities which have value for making progress in the game world. User evaluations with patients under pediatric supervision revealed that the use of mobile technology in combination with web-based elements is feasible but some assumptions made about how users would connect to the platform were not satisfied in reality, resulting in less than optimal user experiences. We discuss challenges with suggestions for further development of integrated pervasive coaching and gamification platforms in medical practice.

Tomorrow's world: current developments in the therapeutic use of technology for psychosis

There is now an established evidence base for the use of information and communication technology (ICT) to support mental healthcare (‘e-mental health’) for common mental health problems. Recently, there have been significant developments in the therapeutic use of computers, mobile phones, gaming and virtual reality technologies for the assessment and treatment of psychosis. We provide an overview of the therapeutic use of ICT for psychosis, drawing on searches of the scientific literature and the internet and using interviews with experts in the field. We outline interventions that are already relevant to clinical practice, some that may become available in the foreseeable future and emerging challenges for their implementation.

Gaming in Nursing Education: A Literature Review

AIM

The aim of this research was to investigate videogame-based learning in nursing education and establish how videogames are currently employed and how they link to the development of decision-making, motivation, and other benefits.

BACKGROUND

Although digital game-based learning potentially offers a safe and convenient environment that can support nursing students developing essential skills, nurse educators are typically slow to adopt such resources.

METHOD

A comprehensive search of electronic databases was conducted, followed by a thematic analysis of the literature.

RESULTS

Evaluations of identified games found generally positive results regarding usability and effectiveness of videogames in nursing education. Analysis of advantages of videogames in nursing education identified potential benefits for decision-making, motivation, repeated exposure, logistical, and financial value.

CONCLUSION

Despite the paucity of games available and the methodological limitations identified, findings provide evidence to support the potential effectiveness of videogames as a learning resource in nursing education.

Breaking Health Insurance Knowledge Barriers Through Games: Pilot Test of Health Care America

BACKGROUND

Having health insurance is associated with a number of beneficial health outcomes. However, previous research suggests that patients tend to avoid health insurance information and often misunderstand or lack knowledge about many health insurance terms. Health insurance knowledge is particularly low among young adults.

OBJECTIVE

The purpose of this study was to design and test an interactive newsgame (newsgames are games that apply journalistic principles in their creation, for example, gathering stories to immerse the player in narratives) about health insurance. This game included entry-level information through scenarios and was designed through the collation of national news stories, local personal accounts, and health insurance company information.

METHODS

A total of 72 (N=72) participants completed in-person, individual gaming sessions. Participants completed a survey before and after game play.

RESULTS

Participants indicated a greater self-reported understanding of how to use health insurance from pre- (mean=3.38, SD=0.98) to postgame play (mean=3.76, SD=0.76); t₇₁=-3.56, P=.001. For all health insurance terms, participants self-reported a greater understanding following game play. Finally, participants provided a greater number of correct definitions for terms after playing the game, (mean=3.91, SD=2.15) than they did before game play (mean=2.59, SD=1.68); t₃₁=-3.61, P=.001. Significant differences from pre- to postgame play differed by health insurance term.

CONCLUSIONS

A game is a practical solution to a difficult health issue-the game can be played anywhere, including on a mobile device, is interactive and will thus engage an apathetic audience, and is cost-efficient in its execution.

Community Game Day: Using an End-of-Life Conversation Game to Encourage Advance Care Planning

CONTEXT

Advance care planning (ACP) is an important process that involves discussing and documenting one's values and preferences for medical care, particularly end-of-life treatments.

OBJECTIVES

This convergent, mixed-methods study assessed whether an end-of-life conversation card game is an acceptable and effective means for performing ACP for patients with chronic illness and/or their caregivers when deployed in a community setting.

METHODS

Twenty-two games (n = 93 participants) were held in community settings surrounding Hershey, PA in 2016. Participants were recruited using random sampling from patient databases and also convenience sampling (i.e., flyers). Quantitative questionnaires and qualitative focus group interviews were administered to assess the game experience and subsequent performance of ACP behaviors.

RESULTS

Both quantitative and qualitative data found that Community Game Day was a well-received, positive experience for participants and 75% of participants performed ACP within three months post-intervention.

CONCLUSIONS

These findings suggest that using a conversation game during community outreach is a useful approach for engaging patients and caregivers in ACP. The convergence of quantitative and qualitative data strongly supports the continued investigation of the game in randomized controlled trials.

Exploring the use of online video games to detect personality dichotomies

Purpose

Personality trait detection is a problem that has been gaining much attention in the computer science field recently. By leveraging users’ personality knowledge software applications are able to adapt their behaviour accordingly. To detect personality traits automatically users must substantially interact with software applications to gather enough information that describe their behaviour. For addressing this limitation, the authors explore the use of online video games as an alternative approach to detect personality dichotomies. The paper aims to discuss these issues.

Design/methodology/approach

The authors analyse the use of several online video games that exhibit features related with Myers-Briggs sensitive-intuitive personality dichotomy. Then, the authors build a user profile that describes users’ behaviour when interacting with online video games. Finally, the authors identify users’ personality by analysing their profile with different classification algorithms.

Findings

The results show that games that obtained better results in the personality dichotomy detection exhibit features that had better match with the sensitive-intuitive dichotomy preferences. Moreover, the results show that the classification algorithms should satisfactorily deal with unbalanced data sets, since it is natural that the frequencies of the dichotomies types are unbalanced. In addition, in the context of personality trait detection, online video games possess several advantages over other type of software applications. By using games, users do not need to have previous experience, since they learn how to play during gameplay. Furthermore, the information and time needed to predict the sensitive-intuitive dichotomy using games is little.

Originality/value

This study shows that online video games are a promising environment in which the users’ personality dichotomies can be detected.

Videogames as Therapy

There is a long history of using videogames in a therapeutic capacity including rehabilitation for stroke patients, people with traumatic brain injuries, burns victims, wheelchair users, Erb's palsy sufferers, children undergoing chemotherapy, children with muscular dystrophy, autistic children and individuals looking to overcome real-life challenges (including symptoms of depression) and boost their wellbeing (including boosting life satisfaction, self-efficacy and social support). This paper briefly and selectively examines a number of areas including: (1) videogames as physiotherapy and occupational therapy, (2) videogames as distractors in the role of pain management, (3) videogames and cognitive rehabilitation, (4) videogames and the development of social and communication skills among the learning disabled, (5) videogames and impulsivity/attention deficit disorders, (6) videogames and therapeutic benefits in the elderly, (7) videogames in psychotherapeutic settings, (8) videogames and health care, (9) videogames and anxiety disorders, and (10) videogames and psychological wellbeing. It is concluded that there has been considerable success when games are specifically designed to address a specific problem or to teach a certain skill. However, generalizability outside the game-playing situation remains an important consideration.

Development, Usability, and Efficacy of a Serious Game to Help Patients Learn About Pain Management After Surgery: An Evaluation Study

Background

Postoperative pain is a persistent problem after surgery and can delay recovery and develop into chronic pain. Better patient education has been proposed to improve pain management of patients. Serious games have not been previously developed to help patients to learn how to manage their postoperative pain.

Objective

The aim of this study was to describe the development of a computer-based game for surgical patients to learn about postoperative pain management and to evaluate the usability, user experience, and efficacy of the game.

Methods

A computer game was developed by an interdisciplinary team following a structured approach. The usability, user experience, and efficacy of the game were evaluated using self-reported questionnaires (AttrakDiff2, Postoperative Pain Management Game Survey, Patient Knowledge About Postoperative Pain Management questionnaire), semi-structured interviews, and direct observation in one session with 20 participants recruited from the general public via Facebook (mean age 48 [SD 14]; 11 women). Adjusted Barriers Questionnaire II and 3 questions on health literacy were used to collect background information.

Results

Theories of self-care and adult learning, evidence for the educational needs of patients about pain management, and principles of gamification were used to develop the computer game. Ease of use and usefulness received a median score between 2.00 (IQR 1.00) and 5.00 (IQR 2.00) (possible scores 0-5; IQR, interquartile range), and ease of use was further confirmed by observation. Participants expressed satisfaction with this novel method of learning, despite some technological challenges. The attributes of the game, measured with AttrakDiff2, received a median score above 0 in all dimensions; highest for attraction (median 1.43, IQR 0.93) followed by pragmatic quality (median 1.31, IQR 1.04), hedonic quality interaction (median 1.00, IQR 1.04), and hedonic quality stimulation (median 0.57, IQR 0.68). Knowledge of pain medication and pain management strategies improved after playing the game (P=.001).

Conclusions

A computer game can be an efficient method of learning about pain management; it has the potential to improve knowledge and is appreciated by users. To assess the game’s usability and efficacy in the context of preparation for surgery, an evaluation with a larger sample, including surgical patients and older people, is required.

Digital games as an effective approach for cancer management: Opportunities and challenges

OBJECTIVE

Cancer is one of the most preventable and common chronic diseases that have economic, social and psychological burden for patients, families, and the society. Cancer can be monitored by new information technology. Digital games as a uniquely powerful interaction tool support optimal care management program operation in all dimensions. The aim of this review article is to describe opportunities and challenges of this new modern technology on the delivery of cancer care services in cancer management domains for cancer care improvement.

METHODS

This study was un-systematic (narrative) review article. In this research, 50 full-text papers and reports had been retrieved, studied exactly, and arranged based on study aims. We searched papers based on specific and relevant keywords in research databases including PubMed, ScienceDirect, Scopus, and Google scholar.

CONCLUSION

In cancer management domain, digital games are as an effective medium for health education and intervention, disease self-management training, attention distraction to relieve pain, enhance clinical outcomes, improvements in lifestyles, and physical and psychosocial activity promotion when active participation and behavior rehearsal are required for cancer patient. In spite of potential benefits of new technology, sometimes people confront various challenges such as social isolation, unusual anxiety, and disorder in physiological times of body, low physical activities, decrease academic performance, increase aggressive behavior, and physical pain. These problems can be partly overcome by proper planning, good design, and usage of suitable and continuous monitoring.

Toward Game-Based Digital Mental Health Interventions: Player Habits and Preferences

Background

Designers of digital interventions for mental health often leverage interactions from games because the intrinsic motivation that results from game-based interventions may increase participation and translate into improved treatment efficacy. However, there are outstanding questions about the suitability (eg, are desktop or mobile interventions more appropriate?) and intervention potential (eg, do people with depression activate enough to play?) of games for mental health.

Objective

In this paper, we aimed to describe the presently unknown relationship between gaming activity and indicators of well-being so that designers make informed choices when designing game-based interventions for mental health.

Methods

We gathered validated scales of well-being (Beck’s Depression Inventory [BDI-II], Patient Health Questionnaire [PHQ-9], trait anxiety [TA], and basic psychological needs satisfaction [BPNS]), play importance (control over game behavior: control; gamer identity: identity), and play behavior (play frequency, platform preferences, and genre preferences) in a Web-based survey (N=491).

Results

The majority of our participants played games a few times a week (45.3%, 222/490) or daily (34.3%, 168/490). In terms of depression, play frequency was associated with PHQ-9 (P=.003); PHQ-9 scores were higher for those who played daily than for those who played a few times a week or less. Similarly, for BDI-II (P=.01), scores were higher for those who played daily than for those who played once a week or less. Genre preferences were not associated with PHQ-9 (P=.32) or BDI-II (P=.68); however, platform preference (ie, mobile, desktop, or console) was associated with PHQ-9 (P=.04); desktop-only players had higher PHQ-9 scores than those who used all platforms. Platform preference was not associated with BDI-II (P=.18). In terms of anxiety, TA was not associated with frequency (P=.23), platform preference (P=.07), or genre preference (P=.99). In terms of needs satisfaction, BPNS was not associated with frequency (P=.25) or genre preference (P=.53), but it was associated with platform preference (P=.01); desktop-only players had lower needs satisfaction than those who used all platforms. As expected, play frequency was associated with identity (P<.001) and control (P<.001); those who played more had identified more as a gamer and had less control over their gameplay. Genre preference was associated with identity (P<.001) and control (P<.001); those who played most common genres had higher control over their play and identified most as gamers. Platform preference was not associated with control (P=.80), but was with identity (P=.001); those who played on all devices identified more as a gamer than those who played on mobiles or consoles only.

Conclusions

Our results suggest that games are a suitable approach for mental health interventions as they are played broadly by people across a range of indicators of mental health. We further unpack the platform preferences and genre preferences of players with varying levels of well-being.

Physical Activity Levels in Children With and Without Autism Spectrum Disorder When Playing Active and Sedentary Xbox Kinect Videogames

OBJECTIVE

We compare physical activity during bouts of sedentary videogaming (SVG), active videogaming (AVG), and paced walking in children with and without autism spectrum disorder (ASD) to determine the effectiveness of AVG in providing moderate-to-vigorous physical activity.

MATERIALS AND METHOD

Participants included nine males (8-11 years old) with ASD and eight age-matched males who were typically developing. Both groups had anthropometric and motor proficiency (Movement Assessment Battery for Children II) measures taken before testing. Participants attended three randomly assigned acquisition sessions: 20 minutes of paced walking at 4.5 metabolic equivalents, AVG, and SVG. Videogaming occurred on an Xbox^® Kinect. An Actical accelerometer provided activity counts (AC) and percentage of time in moderate-to-vigorous physical activity (%MVPA). These were compared using 3 × 2 repeated measures analysis of variance for each measure.

RESULTS

Main effects for conditions existed for %MVPA (P < 0.0001) and AC (P < 0.0001). Post hoc Bonferroni comparisons indicated that AVG had significantly higher AC (P < 0.001) and % MVPA (P < 0.001) than SVG, but was significantly lower than paced walking (AC P < 0.001; %MVPA P < 0.01). Overall, participants spent 76.25% of their time in MVPA during AVG compared to 99.4% during paced walking and 2.31% in SVG. No main effects for groups or group by condition interaction effects were found for either measure.

CONCLUSIONS

AVG may provide an appealing means by which all individuals can increase their overall physical activity levels, although AVG should not be seen as a replacement for walking or other forms of PA. Although further research is necessary, the finding that both groups performed similarly in AVG suggests that games can potentially be played without modifications or adaptations to gaming units, which may provide several advantages in terms of social/cost/ease of accessing unit.

Perspectives on Technology-Assisted Relaxation Approaches to Support Mind-Body Skills Practice in Children and Teens: Clinical Experience and Commentary

It has been well-established that a variety of mind-body (MB) techniques, including yoga, mental imagery, hypnosis, biofeedback, and meditation, are effective at addressing symptoms such as pain, anxiety, nausea, and insomnia, as well as helping with a wide variety of medical, emotional, and behavioral issues in pediatric populations. In addition, MB skills can also be health-promoting in the long-term, and with regular practice, could potentially contribute to longer attention spans, social skills, emotional regulation, and enhanced immune system functioning. Importantly, the benefits accrued from MB skills are largely dose-dependent, meaning that individuals who practice with some consistency tend to benefit the most, both in the short- and long-term. However, clinical experience suggests that for busy patients, the regular practice of MB skills can be challenging and treatment adherence commonly becomes an issue. This commentary reviews the concept of technology-assisted relaxation as an engaging and effective option to enhance treatment adherence (i.e., daily practice) for pediatric patients, for whom MB skills have been recommended to address physical and mental health challenges.

Skill training preferences and technology use in persons with neck and low back pain

BACKGROUND

Neck pain (NP) and low back pain (LBP) are highly prevalent. Exercise therapy helps, but effect sizes and therapy compliance remain low. Client-centred therapy and technology use may play a role to improve therapy outcomes. To offer technology supported rehabilitation matching patient's goals, training preferences for rehabilitation and technology familiarity need to be known.

PURPOSE

This study aims to (1) inventory training preferences and motives, (2) evaluate whether these change during rehabilitation, and (3) evaluate familiarity with using technologies, in persons with NP/LBP.

METHOD

Semi-structured interviews were conducted with regard to training preferences and usage of mainstream technological devices.

RESULTS

Persons with NP (n = 40) preferred to train on "lifting", "prolonged sitting" and "driving a car". Persons with LBP (n = 40) preferred to train on "household activities", "lifting" and "prolonged walking". Motives were predominantly "ability to work" and "ability to do free time occupations". Preferences shifted in ranking but remained the same during rehabilitation. Participants were familiar with the surveyed technologies.

CONCLUSION

Persons with NP or LBP prefer to train on exercises supporting the improvement of everyday life skills. They use technologies in their professional and personal life, which may lower the threshold for the adoption of rehabilitation technologies. Implications for rehabilitation Persons with neck pain (NP) and persons with low back pain (LBP) prefer to train on specific activities that limit their functional ability during daily tasks. The underlying motives linked to preferred training activities are predominantly "being able to work" and "being able to perform free time occupations". Persons with NP and persons with LBP are accustomed to the use of mainstream technologies and the integration of these technologies in rehabilitation settings seems feasible. In order to enable technology supported rehabilitation that is client-centred, technologies need to offer an extensive number of exercises that support (components of) patient training preferences.

Exploring the Topics Discussed During a Conversation Card Game About Death and Dying: A Content Analysis

CONTEXT

Substantive discussions between loved ones are necessary for effective advance care planning. Although multiple tools are currently in use for promoting conversations, the content and clinical relevance of the conversations they stimulate is unknown.

OBJECTIVE

To describe the content and clinical relevance of conversations that occur during a nonfacilitated end-of-life conversation game.

METHODS

Using convenience sampling, we scheduled adult volunteers to participate in an end-of-life conversation game (2-6 individuals per game; n = 68). Participants discussed 20 questions about death, dying, or end-of-life issues. Games lasted up to two hours and were audio-recorded, transcribed, and analyzed using a conventional qualitative content analysis approach to identify emerging themes.

RESULTS

Participants (n = 68) were primarily Caucasian (94%), females (68%), with mean age of 51.3 years (SD 0.7). Seventeen games were analyzed. Four primary themes emerged during game conversations: 1) the importance of people, relationships, and the roles played during end-of-life decision making, 2) values, beliefs, and preferences related to end-of-life care and the dying period, 3) considerations about preparing for the aftermath of one's death, and 4) the relevance of stories or experiences for informing one's own end-of-life preferences.

CONCLUSIONS

Topics discussed during a nonfacilitated end-of-life conversation game are substantive and address important issues for advance care planning.

Gaming for Safer Sex: Young German and Turkish People Report No Specific Culture-Related Preferences Toward Educational Games Promoting Safer Sex

OBJECTIVE

Comprehensive sex education programs specifically designed for adolescents and young adults that take into account gender norms and cultural background have shown promise as a means of countering the high sexually transmitted infection rate in young people. Recently, digital gaming interventions delivered on computers or mobile devices have emerged as another way to promote safer sex behavior in a young population. Tailoring these computer-based interventions to their target population has been recognized to increase positive behavior outcomes. In this qualitative study, we investigated whether young female and male adults from two different cultural backgrounds (all living in Germany) would have different preferences and needs in relation to an educational game promoting safer sex.

MATERIALS AND METHODS

We conducted four semistructured focus group interviews comprising open-ended questions with male and female participants who had either a German or a Turkish background. In total, 20 individuals, aged between 18 and 22 years, from two socially diverse and ethnically mixed vocational schools in Germany participated.

RESULTS

Independent of cultural background and gender, participants preferred a real-world design with a first-person visual perspective over a fantasy-like third-person perspective. Furthermore, they preferred highly customizable avatars. All participants mentioned the importance of including an alcohol-intoxicated avatar and most participants wanted there to be additional information available about various safer sex approaches and about the use of different barrier protection methods. Males and females reported similar preferences for the design of an educational game promoting safer sex, with the only difference being exactly how the topic of having sexual intercourse should be addressed in the game. Males preferred a direct approach, whereas females had a preference for treating this subject more sympathetically.

CONCLUSION

Educational games offer anonymity and can provide young people across different cultural backgrounds with gender-tailored opportunities to experiment with specific safer sex precautions in a nonthreatening virtual environment, free from unwanted parental control and peer monitoring.

Exergaming (XBOX Kinect™) versus traditional gym-based exercise for postural control, flow and technology acceptance in healthy adults: a randomised controlled trial

BACKGROUND

The use of exergaming is a potential alternative to traditional methods of balance training, which can be repetitive and somewhat monotonous. The purpose of this study was to assess the effects of exergaming using XBOX Kinect™ versus traditional gym-based exercise with no virtual stimuli (TGB) on postural control, technology acceptance, flow experience and exercise intensity, in young healthy adults.

METHODS

Fifty healthy active adults (age: 33.8 ± 12.7 years, height: 172.9 ± 11.9 cm, weight: 75 ± 15.8 kg) were recruited; 44 completed both baseline and post-intervention data collection. Participants were randomised (blind card) allocation to one of two groups: (1) received balance training using the XBOX Kinect™ and (2) performed traditional gym-based exercise. Exercises were matched for intensity, duration and movement patterns across groups. All participants completed three, 30-minute, exercise sessions a week for four weeks. Postural sway was measured using a Kistler™ Force platform during unipedal standing. Mean heart rate (HR) and rate of perceived exertion (RPE) were collected during each exercise session to determine and verify that intensity of exercise was matched between groups. Technology acceptance was measured with the Unified Theory of Acceptance and Use of Technology (UTAUT) and flow experience with the Flow State Scale (FSS).

RESULTS

Heart rate was matched between groups and BORG RPE was significantly lower in the Kinect™ group. There were significant between-group differences in postural sway in the medial-lateral direction and CoP. There were also significant differences in technology acceptance between groups for performance expectancy, social influence and behavioral intention, with higher values in the Kinect exercise group. The flow state scale showed significant differences between the groups on several dimensions, with higher values in the Kinect exercise group.

CONCLUSION

Objective physiological demand of exercise (HR) was matched across groups, but the exergaming group perceived it as being less demanding and of lower intensity. This suggests that exergaming may offer an alternative method of rehabilitation exercise through improved concordance. Balance training in healthy adults using the Kinect is both accepted and intrinsically motivating.

TRIAL REGISTRATION

Retrospectively registered on 27th July 2016. Trial number NCT02851017.

Can Playing an End-of-Life Conversation Game Motivate People to Engage in Advance Care Planning?

BACKGROUND

Advance care planning (ACP) involves several behaviors that individuals undertake to prepare for future medical care should they lose decision-making capacity. The goal of this study was to assess whether playing a conversation game could motivate participants to engage in ACP.

METHODS

Sixty-eight English-speaking, adult volunteers (n = 17 games) from communities around Hershey, Pennsylvania, and Lexington, Kentucky, played a conversation card game about end-of-life issues. Readiness to engage in 4 ACP behaviors was measured by a validated questionnaire (based on the transtheoretical model) immediately before and 3 months postgame and a semistructured phone interview. These behaviors were (1) completing a living will; (2) completing a health-care proxy; (3) discussing end-of-life wishes with loved ones; and (4) discussing quality versus quantity of life with loved ones.

RESULTS

Participants' (n = 68) mean age was 51.3 years (standard deviation = 0.7, range: 22-88); 94% of the participants were caucasian and 67% were female. Seventy-eight percent of the participants engaged in ACP behaviors within 3 months of playing the game (eg, updating documents, discussing end-of-life issues). Furthermore, 73% of the participants progressed in stage of change (ie, readiness) to perform at least 1 of the 4 behaviors. Scores on measures of decisional balance and processes of change increased significantly by 3 months postintervention.

CONCLUSION

This pilot study found that individuals who played a conversation game had high rates of performing ACP behaviors within 3 months. These findings suggest that using a game format may be a useful way to motivate people to perform important ACP behaviors.

Use of Gaming in Self-Management of Diabetes in Teens

With the growing prevalence of diabetes in teens and frequent concomitant problems with adherence, adolescents are a frequent target for diabetes self-management support and education. Due to widespread use of technology among teens in general, the use of serious games, games used for purposes beyond entertainment with the intention to educate and support health behavior for teens with diabetes self-management, is an emerging and promising practice. This report explores games intended for teens with diabetes, how the use of games may enhance clinical practice, and provides suggestions for future research and better utilization of these technologies. Current research on the use of gaming for promoting diabetes management in teens is fairly limited, with some initial support for improvements in both behavioral and clinical outcomes among teens. More research is clearly needed in order to further determine how gaming can best be utilized to impact health outcomes in these teens, as well as potential mechanisms of change.

A Feasibility Study on the Effectiveness of a Full-Body Videogame Intervention for Decreasing Attention Deficit Hyperactivity Disorder Symptoms

OBJECTIVE

The current study assessed the feasibility and effectiveness of a full-body-driven intervention videogame targeted at decreasing attention deficit hyperactivity disorder (ADHD) symptoms, specifically inattention, hyperactivity, impulsivity, and motor deficiency.

MATERIALS AND METHODS

The game was tested in a Dutch sample (N = 73) of school-aged children with elevated ADHD symptoms. Children assigned to the intervention condition played "Adventurous Dreaming Highflying Dragon," and those in the control condition played a comparable full-body-driven game without ADHD-focused training components. Games were played during six 15-minute sessions. Outcomes were teacher-rated ADHD symptoms and scores on neuropsychological tasks assessing motor skills, impulsivity, and sustained attention.

RESULTS

There was some indication of greater improvement in the intervention group in comparison to the control group in terms of teacher-rated ADHD symptoms. Both groups showed equal indication of improvement in fine motor skills, but no change was found in gross motor skills. Additionally, both groups showed a deterioration in number of hits (assessing sustained attention) on the go/no-go task. Last, the intervention group showed a greater increase in false alarms (assessing impulsivity) than the control group.

CONCLUSION

Dragon seems promising as a game-based intervention for children with ADHD. Children who played Dragon improved in several areas with only a short amount of gameplay (1.5 hours in total), and their satisfaction with the game was high. For future research, it is recommended to further inspect Dragon's influence on impulsivity and gross motor skills. Furthermore, it is recommended to disentangle, examine, and evaluate specific properties of videogames that might lead to positive behavioral change.

Epic Allies: Development of a Gaming App to Improve Antiretroviral Therapy Adherence Among Young HIV-Positive Men Who Have Sex With Men

Background

In the United States, the human immunodeficiency virus (HIV) disproportionately affects young men who have sex with men (YMSM). For HIV-positive individuals, adherence to antiretroviral therapy (ART) is critical for achieving optimal health outcomes and reducing secondary transmission of HIV. However, YMSM often struggle with ART adherence. Novel mobile phone apps that incorporate game-based mechanics and social networking elements represent a promising intervention approach for improving ART adherence among YMSM.

Objective

This study used a multiphase, iterative development process to create an ART adherence app for YMSM.

Methods

The three-phase development process included: (1) theory-based concept development jointly by public health researchers and the technology team, (2) assessment of the target population’s ART adherence needs and app preferences and development and testing of a clickable app prototype, and (3) development and usability testing of the final app prototype.

Results

The initial theory-based app concept developed in Phase One included medication reminders, daily ART adherence tracking and visualization, ART educational modules, limited virtual interactions with other app users, and gamification elements. In Phase Two, adherence needs, including those related to information, motivation, and behavioral skills, were identified. Participants expressed preferences for an ART adherence app that was informational, interactive, social, and customizable. Based on the findings from Phase Two, additional gaming features were added in Phase Three, including an interactive battle, superhero app theme, and app storyline. Other features were modified to increase interactivity and customization options and integrate the game theme. During usability testing of the final prototype, participants were able to understand and navigate the app successfully and rated the app favorably.

Conclusions

An iterative development process was critical for the development of an ART adherence game app that was viewed as highly acceptable, relevant, and useful by YMSM.

Acceptance of Serious Games in Psychotherapy: An Inquiry into the Stance of Therapists and Patients

BACKGROUND

Serious games are computer or video games that contain elements that are specifically designed for the purpose of education or training. Serious games are increasingly being used within healthcare, but their introduction into and application in psychotherapeutic settings as an e-mental health treatment modality raises questions for both patients and therapists. Current research demonstrates the potential role and effectiveness of serious games within a psychotherapeutic context. However, a limited understanding of patients' and therapists' existing knowledge and experience of serious games, as well as of their readiness to utilize and apply them for the treatment of psychological conditions, requires further investigation.

MATERIALS AND METHODS

Acceptance, experience, and requirements for the utilization of serious games in therapeutic contexts were assessed through online surveys with German-speaking patients (n = 260) and psychotherapists (n = 234). Respondents' answers were analyzed by a combination of descriptive and inferential statistics by using SPSS.

RESULTS

Current knowledge regarding serious games was very limited, with only 10.4% of patients and 11.5% of therapists reporting existing knowledge. However, a general openness toward the concept was observed: 88% of patients and 90% of therapists could envisage a therapeutic use. Patients (rs = 0.169, p = 0.006) who self-rated their level of computer and video game expertise as high were more likely to consider use within psychotherapy, compared with patients who self-rated their expertise as low. Therapists who currently play computer and video games perceive fewer disadvantages of serious game application in a psychotherapeutic context (p = 0.097). Consideration of serious game use was differentiated by the therapeutic approach (p = 0.003), specific mental disorders (highest rated relevant cases: anxiety disorders, affective disorders, disorders regarding impulse control, and adjustment disorders), and patient age (i.e., use with young adults was deemed the most appropriate by 91.8% of therapists).

CONCLUSION

The application of serious games is conceivable for patients and therapists, especially as a complementary element to traditional face-to-face psychotherapy. Acceptance is strongly related to therapeutic context. Only a small number of therapists and patients agree on the possibility of using a serious game instead of face-to-face therapy.

Conversation Game Effectively Engages Groups of Individuals in Discussions about Death and Dying

BACKGROUND

Discussions about end-of-life (EOL) values, wishes, and beliefs are critical for effective advance care planning (ACP). New strategies are needed to engage individuals in EOL conversations.

OBJECTIVE

The study objective was to test the feasibility of using a conversation game to engage individuals in EOL discussions.

METHODS

This study used a mixed-methods approach. Participants played a conversation game that prompts players to answer and discuss 20 questions about death, dying, and EOL care. Participants completed pre- and postgame questionnaires and participated in postgame focus groups. Subjects were 70 healthy volunteers (18 groups of families, friends, or strangers). Demographics, emotional state, and perceived relational closeness were measured using preintervention questionnaires. Postintervention questionnaires measured conversation satisfaction, realism, self-rated quality, and emotional state. Postgame focus groups evaluated players' experiences playing the game.

RESULTS

Using a seven-point Likert scale (1 = low score, 7 = high score), players rated game conversations as satisfying (mean [M] = 6.1, SD = 0.9), realistic (M = 5.6, SD = 0.8), and of high quality (M = 5.7, SD = 0.9). There were no negative effects on emotional state immediately postgame (M = 1.3, SD = 0.5). A thematic analysis of participants' experiences (n = 55) revealed that (1) playing the game was an enjoyable, positive experience; (2) a game is a good framing for EOL discussions; and (3) there were mixed opinions about ideal game group composition.

CONCLUSIONS

This study established that healthy volunteers enjoyed engaging in a two-hour discussion about EOL issues when framed as a game. The game experience was a positive, satisfying, and enjoyable activity for participants. Further studies are needed to determine if health games can promote effective ACP.

Behavioral Outcome Effects of Serious Gaming as an Adjunct to Treatment for Children With Attention-Deficit/Hyperactivity Disorder: A Randomized Controlled Trial

Background

The need for accessible and motivating treatment approaches within mental health has led to the development of an Internet-based serious game intervention (called “Plan-It Commander”) as an adjunct to treatment as usual for children with attention-deficit/hyperactivity disorder (ADHD).

Objective

The aim was to determine the effects of Plan-It Commander on daily life skills of children with ADHD in a multisite randomized controlled crossover open-label trial.

Methods

Participants (N=170) in this 20-week trial had a diagnosis of ADHD and ranged in age from 8 to 12 years (male: 80.6%, 137/170; female: 19.4%, 33/170). They were randomized to a serious game intervention group (group 1; n=88) or a treatment-as-usual crossover group (group 2; n=82). Participants randomized to group 1 received a serious game intervention in addition to treatment as usual for the first 10 weeks and then received treatment as usual for the next 10 weeks. Participants randomized to group 2 received treatment as usual for the first 10 weeks and crossed over to the serious game intervention in addition to treatment as usual for the subsequent 10 weeks. Primary (parent report) and secondary (parent, teacher, and child self-report) outcome measures were administered at baseline, 10 weeks, and 10-week follow-up.

Results

After 10 weeks, participants in group 1 compared to group 2 achieved significantly greater improvements on the primary outcome of time management skills (parent-reported; P=.004) and on secondary outcomes of the social skill of responsibility (parent-reported; P=.04), and working memory (parent-reported; P=.02). Parents and teachers reported that total social skills improved over time within groups, whereas effects on total social skills and teacher-reported planning/organizing skills were nonsignificant between groups. Within group 1, positive effects were maintained or further improved in the last 10 weeks of the study. Participants in group 2, who played the serious game during the second period of the study (weeks 10 to 20), improved on comparable domains of daily life functioning over time.

Conclusions

Plan-It Commander offers an effective therapeutic approach as an adjunct intervention to traditional therapeutic ADHD approaches that improve functional outcomes in daily life.

Trial Registration

International Standard Randomized Controlled Trial Number (ISRCTN): 62056259; http://www.controlled-trials.com/ISRCTN62056259 (Archived by WebCite at http://www.webcitation.org/6eNsiTDJV).

Serious Games for Mental Health: Are They Accessible, Feasible, and Effective? A Systematic Review and Meta-analysis

INTRODUCTION

The development and use of serious games for mental health disorders are on the rise. Yet, little is known about the impact of these games on clinical mental health symptoms. We conducted a systematic review and meta-analysis of randomized controlled trials that evaluated the effectiveness of serious games on symptoms of mental disorder.

METHOD

We conducted a systematic search in the PubMed, PsycINFO, and Embase databases, using mental health and serious games-related keywords. Ten studies met the inclusion criteria and were included in the review, and nine studies were included in the meta-analysis.

RESULTS

All of the serious games were provided via personal computer, mostly on CD-ROM without the need for an internet connection. The studies targeted age groups ranging from 7 to 80 years old. The serious games focused on symptoms of depression (n = 2), post-traumatic stress disorder (n = 2), autism spectrum disorder (n = 2), attention deficit hyperactivity disorder (n = 1), cognitive functioning (n = 2), and alcohol use disorder (n = 1). The studies used goal-oriented (n = 4) and cognitive training games (n = 6). A total of 674 participants were included in the meta-analysis (380 in experimental and 294 in control groups). A meta-analysis of 9 studies comprising 10 comparisons, using a random effects model, showed a moderate effect on improvement of symptoms [g = 0.55 (95% confidence interval 0.28-0.83); P < 0.001], favoring serious games over no intervention controls.

DISCUSSION/CONCLUSION

Though the number of comparisons in the meta-analysis was small, these findings suggest that serious gaming interventions may be effective for reducing disorder-related symptoms. More studies are needed in order to attain deeper knowledge of the efficacy for specific mental disorders and the longer term effects of this new type of treatment for mental disorders.

Physiological Modalities for Relaxation Skill Transfer in Biofeedback Games

We present an adaptive biofeedback game for teaching self-regulation of stress. Our approach consists of monitoring the user's physiology during gameplay and adapting the game using a positive feedback loop that rewards relaxing behaviors and penalizes states of high arousal. We evaluate the approach using a casual game under three biofeedback modalities: electrodermal activity, heart rate variability, and breathing rate. The three biosignals can be measured noninvasively with wearable sensors, and represent different degrees of voluntary control and selectivity toward arousal. We conducted an experiment trial with 25 participants to compare the three modalities against a standard treatment (deep breathing) and a control condition (the game without biofeedback). Our results indicate that breathing-based game biofeedback is more effective in inducing relaxation during treatment than the other four groups. Participants in this group also showed greater retention of the relaxation skills (without biofeedback) during a subsequent stressor.

Educational Game Development Approach to a particular case: the donor's evaluation

BACKGROUND

Serious games are a current trend nowadays. Almost every sector has used serious games in recent years for different educational purposes. The eLearning research team of the Complutense University of Madrid main focus of research is the development of low-cost serious games. During the past 10 years, we have been working with and developing serious games, paying special attention to those related to healthcare.

METHODS

From all these studies, a methodology was defined-the Educational Game Development Approach (EGDA)-to design, develop, and evaluate game-like simulations or serious games in healthcare. We present the application of the EGDA to a particular case, the development of a serious game representing the donor's evaluation in an intensive care unit from the point of view of a hospital coordinator following the EGDA methodology. In this simulation, we changed the strategy of selection of teaching cases by exponentially increasing the number of teaching cases.

RESULTS

This kind of educational content provides several benefits to students as they learn while playing; they receive immediate feedback of mistakes and correct moves and an objective assessment. These simulations allow the students to practice in a risk-free environment. Moreover, the addition of game elements increases engagement and promotes the retention of important information.

CONCLUSIONS

A game-like simulation has been developed through the use of this methodology. This simulation represents a complex medical procedure.

Games for Health for Children-Current Status and Needed Research

Videogames for health (G4H) offer exciting, innovative, potentially highly effective methods for increasing knowledge, delivering persuasive messages, changing behaviors, and influencing health outcomes. Although early outcome results are promising, additional research is needed to determine the game design and behavior change procedures that best promote G4H effectiveness and to identify and minimize possible adverse effects. Guidelines for ideal use of different types of G4H by children and adolescents should be elucidated to enhance effectiveness and minimize adverse effects. G4H stakeholders include organizational implementers, policy makers, players and their families, researchers, designers, retailers, and publishers. All stakeholders should be involved in G4H development and have a voice in setting goals to capitalize on their insights to enhance effectiveness and use of the game. In the future, multiple targeted G4H should be available to meet a population's diverse health needs in developmentally appropriate ways. Substantial, consistent, and sophisticated research with appropriate levels of funding is needed to realize the benefits of G4H.

Using a digital game for training desirable behavior in cognitive-behavioral therapy of burnout syndrome: a controlled study

Burnout is a globally increasing illness, and as a result, many forms of burnout therapy have arisen. The use of digital games can be psychotherapeutically effective because they can transform exercises that are by themselves unattractive into intrinsically motivated action. This pilot study aims to test whether a specially designed game contributes to patients learning desired behavior and achieving other specific therapeutic goals in an online cognitive-behavioral therapy (CBT)-based burnout treatment context. In total, 101 participants took part in the experiment, under four conditions: (a) Game+Therapy, (b) Therapy Only, (c) Game Only, and (d) No Game+No Therapy. Pre- and postmeasures were taken online. Results showed that the two therapy conditions (Game+Therapy and Therapy Only) showed a greater decrease in complaints and disengagement, and a stronger increase in coping skills than the nontherapy conditions (Game Only and No Game+No Therapy). As expected, the Game+Therapy condition outperformed the Therapy Only condition on combined improvement measures of burnout symptoms. However, analyses of individual measures showed no effects. It can be cautiously concluded that the therapeutic digital game may be a useful tool when embedded in a therapeutic burnout treatment program and is probably more efficient than CBT, as it is used in current practice.