Revealing the theoretical basis of gamification: A systematic review and analysis of theory in research on gamification, serious games and game-based learning

Impact of Facilitation on Cognitive Flow in a Novel Diabetes Management Rehearsal Game for Health Professions Education: Mixed Methods, Open-Label, Superiority Randomized Controlled Trial

BACKGROUND

Though the prevalence of diabetes is set to increase, most serious game solutions typically target patient self-management and education. Few games target health care professions education, and even fewer consider the factors that may increase their efficacies. The impact of facilitation, a prominent feature of health professions education, is examined in the context of a rehearsal-based diabetes management serious game.

OBJECTIVE

In this mixed methods, open-label, superiority randomized controlled trial, we compare student performance, attitudes, and perceptions of a rehearsal-based diabetes management game for health care professionals.

METHODS

Student participants were randomized into 2 groups to play a diabetes management game. The control group played the game alone, and the intervention group played the same game alongside a facilitator tasked to moderate overall challenge levels and address queries. Both groups were administered the Flow Short Scale, a 13-item measure rated on a 7-point Likert scale ranging from 1 ("not at all") to 7 ("very much") immediately after the game. Students were then invited to voluntary focus group discussions to elicit their attitudes and perceptions of the game. Findings were subject to between-group comparisons and inductive thematic analysis respectively.

RESULTS

A total of 48 (26 control, 22 intervention) clinical-year undergraduates from the Lee Kong Chian School of Medicine in Singapore participated in this study, with 18 continuing to the focus group discussions. Flow Short Scale results indicated the superiority of the intervention group for overall flow (t46=-2.17, P=.04) and the absorption subdomain (t46=-2.6, P=.01). Qualitative results indicated students viewed facilitation as helpful and appropriate, and were able to identify improvable elements of the game's theoretical foundations and overall design.

CONCLUSIONS

While serious games are efficacious means of rehearsing previously learned knowledge, facilitation allows for their efficiency to be greatly increased. Such increases are likely crucial in the coming years with the increased digitization of health care professions education and the prevalence of diabetes.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05637749; https://www.clinicaltrials.gov/study/NCT05637749.

A mobile device-based game prototype for ADHD: development and preliminary feasibility testing

This research aimed to devise and assess a mobile game therapy software for children with Attention-Deficit/Hyperactivity Disorder (ADHD), as well as evaluating its suitability and effectiveness in improving the cognitive ability of typically developing children. The study encompassed 55 children diagnosed with ADHD and 55 neurotypical children. Initial assessments involved ADHD-related scales, computerized tests for information processing, and physiological-psychological evaluations. After a 4-week home-based game intervention, participants underwent re-evaluation using baseline measures and provided feedback on treatment satisfaction. Considering the small proportion of study participants who dropped out, data was analyzed using both the Intention-to-Treat (ITT) analysis and the Per-protocol (PP) analysis. The trial was registered at ClinicalTrials.gov (NCT06181747). In ITT analysis, post-intervention analysis using linear mixed models indicated that the ADHD group improved significantly more than the neurotypical group particularly in Continuous Performance Test (CPT) accuracy (B = -23.92, p < 0.001) and reaction time (B = 86.08, p < 0.01), along with enhancements in anti-saccade (B = -10.65, p < 0.05) and delayed-saccade tasks (B = 0.34, p < 0.05). A reduction in parent-rated SNAP-IV scores was also observed (B = 0.43, p < 0.01). In PP analysis, paired-sample t-tests suggested that the ADHD group had significant changes pre- and post-intervention, in terms of CPT Accuracy (t = -7.62, p < 0.01), Anti-saccade task Correct Rate (t = -3.90, p < 0.01) and SNAP-IV scores (t = -4,64, p < 0.01). However, no significant changes post-intervention were observed in the neurotypical group. Survey feedback highlighted a strong interest in the games across both groups, though ADHD participants found the game more challenging. Parents of ADHD children reported perceived benefits and a willingness to continue the game therapy, unlike the neurotypical group's parents. The findings advocated for the integration of serious video games as a complementary tool in ADHD treatment strategies, demonstrating the potential to augment attentional abilities and alleviate clinical symptoms. However, a randomized controlled trial (RCT) is needed to further verify its efficacy.

"Aquilibria: The battle to balance"-a narrative card and board game on acid-base regulation for first-year medical students

Recognizing the growing value of game-based learning in medical education, this study aims to evaluate the effectiveness of the innovation, "Aquilibria: The Battle to Balance," a creative narrative card and board game to help improve learners' understanding and application of the concepts of acid-base balance. In this mixed-method study, 120 first-year medical students participated. The innovation employed a card and board style integrated with a captivating story. Students were divided into small groups of six each with a facilitator. Following this, the posttest was conducted to compare the educational gain. Also, students' perceptions about the game were obtained using a 32-item questionnaire on a 5-point Likert scale. In addition to this, the confidence level among students to understand and interpret the concepts of acid-base regulation before and after the game was obtained using a 10-item questionnaire on a 5-point Likert scale. Furthermore, for qualitative data, short interviews with open-ended questions were conducted and thematic analysis was performed. The results showed a highly significant improvement in academic performance from a pretest score of 7.57 ± 1.07 (means ± SD) to 16.14 ± 1.80 in the posttest with a P value of <0.0001. There was a notable increase in confidence among learners after the game, and highly positive student feedback was received. These findings support the growing recognition of narrative game-based learning as a valuable and engaging strategy in medical education, offering a promising avenue for fostering deeper understanding and retention of complex medical concepts.NEW & NOTEWORTHY This innovation is a captivating blend of storytelling, cards, and board gameplay to facilitate the learning of acid-base regulation. This engaging game offers a wealth of questions and diverse case scenarios, allowing learners to repeatedly explore and grasp the intricacies of acid-base balance. What sets this game apart is its robust assessment strategy, supported by overwhelmingly positive feedback and marked academic improvement. This innovation is a must-have for students seeking a dynamic and effective learning experience.

Investigating the influence of gamification on motivation and learning outcomes in online language learning

Introduction

This study investigates the influence of gamification integration on language learning achievement among Chinese students while probing the mediating role of learners' motivation. Furthermore, it extends the boundaries of this investigation by exploring the moderating effect of digital literacy as a psychological predisposition.

Methods

Data is collected through surveys from Chinese students enrolled in linguistic programs, employing a stratified random sampling technique and analyzed via SmartPLS SEM.

Results

The findings affirm the significant and positive impact of gamification integration on language learning achievement. The study introduces a moderated mediation model where learners' motivation serves as the mediator, and digital literacy acts as a moderator, further accentuating the significant impact of this integrated approach.

Discussion

This research advances our theoretical understanding of language learning, validating gamification's effectiveness as a motivational tool, and introduces digital literacy as a critical factor, providing deeper insights into personalized language learning experiences.

Enhancing ESG learning outcomes through gamification: An experimental study

This study investigates the effectiveness of gamification in enhancing learning outcomes in Environmental, Social, and Governance (ESG) education. Employing a cluster randomized experiment, the research involved 22 classes from four universities, divided into gamified and traditional teaching groups. The gamified group engaged with ESG concepts through interactive, game-like elements, while the control group followed standard educational practices. The study aimed to determine whether gamification could improve ESG course effectiveness and enhance Psychological Ownership and Perceived Importance, thereby influencing learning outcomes. Data collected through post-experiment surveys were analyzed using multiple linear regression and Structural Equation Modeling (SEM). Results indicated that students in the gamified group performed significantly better in ESG exams compared to the control group, demonstrating the effectiveness of gamification in enhancing academic achievement. The SEM analysis further revealed that gamification positively impacted Psychological Ownership and Perceived Importance, which in turn significantly improved academic performance. These findings suggest that incorporating gamification in ESG education can effectively engage students and deepen their understanding of complex sustainability issues. This study contributes to the field by highlighting the potential of gamification as a transformative tool in higher education, particularly in teaching abstract and multifaceted subjects like ESG.

GridlockED as an Intervention for Nurses (GAAIN) Study

BACKGROUND

GridlockED (The Game Crafter, LLC) is a serious game that was developed to teach challenges that face nursing and medical professionals in the emergency department (ED). However, few studies have explored nurses' perceptions of the utility, fidelity, acceptability, and applicability of the serious game modality. This study examined how ED nurses view GridlockED as a continuing education platform.

METHOD

This single-center observational study explored how nurses engage with and respond to Grid-lockED. The convenience sample included participants recruited from a local continuing nursing education day. Participants completed a presurvey, engaged in a full game play session with the GridlockED game for approximately 45 minutes, and immediately completed a post-game play survey.

RESULTS

Of the 48 participants (11 male, 37 female; 44 of 48 were RNs), most (91%) agreed that the workflow reflected in the game was equivalent to the flow in a typical ED. Almost all (96%) found the cases in the game reflective of real ED patients, and most (92%) found the game a useful educational tool to prepare new nurses to transition into the ED environment.

CONCLUSION

The GridlockED game shows potential as a serious game to support nursing education, particularly for new ED nurse orientation and transition to ED practice. [J Contin Educ Nurs. 2024;55(5):231-238.].

Effects of a Serious Smartphone Game on Nursing Students' Theoretical Knowledge and Practical Skills in Adult Basic Life Support: Randomized Wait List-Controlled Trial

BACKGROUND

Retention of adult basic life support (BLS) knowledge and skills after professional training declines over time. To combat this, the European Resuscitation Council and the American Heart Association recommend shorter, more frequent BLS sessions. Emphasizing technology-enhanced learning, such as mobile learning, aims to increase out-of-hospital cardiac arrest (OHCA) survival and is becoming more integral in nursing education.

OBJECTIVE

The aim of this study was to investigate whether playing a serious smartphone game called MOBICPR at home can improve and retain nursing students' theoretical knowledge of and practical skills in adult BLS.

METHODS

This study used a randomized wait list-controlled design. Nursing students were randomly assigned in a 1:1 ratio to either a MOBICPR intervention group (MOBICPR-IG) or a wait-list control group (WL-CG), where the latter received the MOBICPR game 2 weeks after the MOBICPR-IG. The aim of the MOBICPR game is to engage participants in using smartphone gestures (eg, tapping) and actions (eg, talking) to perform evidence-based adult BLS on a virtual patient with OHCA. The participants' theoretical knowledge of adult BLS was assessed using a questionnaire, while their practical skills were evaluated on cardiopulmonary resuscitation quality parameters using a manikin and a checklist.

RESULTS

In total, 43 nursing students participated in the study, 22 (51%) in MOBICPR-IG and 21 (49%) in WL-CG. There were differences between the MOBICPR-IG and the WL-CG in theoretical knowledge (P=.04) but not in practical skills (P=.45) after MOBICPR game playing at home. No difference was noted in the retention of participants' theoretical knowledge and practical skills of adult BLS after a 2-week break from playing the MOBICPR game (P=.13). Key observations included challenges in response checks with a face-down manikin and a general neglect of safety protocols when using an automated external defibrillator.

CONCLUSIONS

Playing the MOBICPR game at home has the greatest impact on improving the theoretical knowledge of adult BLS in nursing students but not their practical skills. Our findings underscore the importance of integrating diverse scenarios into adult BLS training.

TRIAL REGISTRATION

ClinicalTrials.gov (NCT05784675); https://clinicaltrials.gov/study/NCT05784675.

Game design elements of serious games in the education of medical and healthcare professions: a mixed-methods systematic review of underlying theories and teaching effectiveness

Serious games, as a learning resource, enhance their game character by embedding game design elements that are typically used in entertainment games. Serious games in its entirety have already proven their teaching effectiveness in different educational contexts including medical education. The embedded game design elements play an essential role for a game's effectiveness and thus they should be selected based on evidence-based theories. For game design elements embedded in serious games used for the education of medical and healthcare professions, an overview of theories for the selection lacks. Additionally, it is still unclear whether and how single game design elements affect the learning effectiveness. Therefore, the main aim of this systematic review is threefold. Firstly, light will be shed on the single game design elements used in serious games in this area. Second, the game design elements' underlying theories will be worked out, and third, the game design elements' effectiveness on student learning outcome will be assessed. Two literature searches were conducted in November 2021 and May 2022 in six literature databases with keywords covering the fields of educational game design, serious game, and medical education. Out of 1006 initial records, 91 were included after applying predefined exclusion criteria. Data analysis revealed that the three most common game design elements were points, storyline, and feedback. Only four underlying theories were mentioned, and no study evaluated specific game design elements. Since game design elements should be based on theories to ensure meaningful evaluations, the conceptual GATE framework is introduced, which facilitates the selection of evidence-based game design elements for serious games.

Efficacy of serious games for chronic pain management in older adults: A systematic review and meta-analysis

AIMS AND OBJECTIVES

To synthesise and appraise the evidence of the efficacy of serious games in reducing chronic pain among older adults.

BACKGROUND

Chronic pain in older adults generally results in a substantial handicap due to decreased mobility, exercise avoidance and various concerns that affect their overall quality of life. While serious games have been widely used as a pain management approach, no reviews have thoroughly examined their efficacy for chronic pain management in older adult populations.

DESIGN

A systematic review and meta-analysis.

METHODS

The CINAHL, the Cochrane Library, Embase, Medline, PubMed and Web of Science databases were comprehensively searched to find articles published from their inception until 17 April 2023. RoB-2 was used to assess the risk of bias in the included studies. The efficacy of serious games for pain management in older individuals was investigated using pooled standardised mean differences (SMDs) in pain reduction using a random effect model.

RESULTS

The meta-analysis comprised nine randomised controlled trials that included 350 older adult patients with pain. Serious games effectively alleviated pain in this group (pooled SMD = -0.62; 95% confidence interval: -1.15 to -0.10), although pain-related disability and fear require further investigation.

CONCLUSIONS

Serious games tended to effectively reduce pain in this older adult group; however, due to a lack of randomised controlled trials, the analysis found lower effectiveness in reducing pain-related disability and fear. Further studies are accordingly required to confirm these findings.

RELEVANCE TO CLINICAL PRACTICE

The findings of the study emphasise the importance of serious games to increase the motivation of older adults to exercise as one of the safe and extensively used pain management strategies. Serious games that effectively reduce chronic pain in older adults are characterised as consisting of diverse physical activities delivered through consoles, computer-based activities and other technologies.

PATIENT OR PUBLIC CONTRIBUTIONS

Serious games are recommended as being potentially useful and practical for reducing pain in older adults.

A Serious Game ("Fight With Virus") for Preventing COVID-19 Health Rumors: Development and Experimental Study

BACKGROUND

Health rumors arbitrarily spread in mainstream social media on the internet. Health rumors emerged in China during the outbreak of COVID-19 in early 2020. Many midelders/elders (age over 40 years) who lived in Wuhan believed these rumors.

OBJECTIVE

This study focused on designing a serious game as an experimental program to prevent and control health rumors. The focus of the study was explicitly on the context of the social networking service for midelders/elders.

METHODS

This research involved 2 major parts: adopting the Transmission Control Protocol model for games and then, based on the model, designing a game named "Fight With Virus" as an experimental platform and developing a cognitive questionnaire with a 5-point Likert scale. The relevant variables for this experimental study were defined, and 10 hypotheses were proposed and tested with an empirical study. In total, 200 participants were selected for the experiments. By collecting relevant data in the experiments, we conducted statistical observations and comparative analysis to test whether the experimental hypotheses could be proved.

RESULTS

We noted that compared to traditional media, serious games are more capable of inspiring interest in research participants toward their understanding of the knowledge and learning of health commonsense. In judging and recognizing the COVID-19 health rumor, the test group that used game education had a stronger ability regarding identification of the rumor and a higher accuracy rate of identification. Results showed that the more educated midelders/elders are, the more effective they are at using serious games.

CONCLUSIONS

Compared to traditional media, serious games can effectively improve midelders'/elders' cognitive abilities while they face a health rumor. The gameplay effect is related to the individual's age and educational background, while income and gender have no impact.

Immersive Virtual Reality-Based Methods for Assessing Executive Functioning: Systematic Review

BACKGROUND

Neuropsychological assessments traditionally include tests of executive functioning (EF) because of its critical role in daily activities and link to mental disorders. Established traditional EF assessments, although robust, lack ecological validity and are limited to single cognitive processes. These methods, which are suitable for clinical populations, are less informative regarding EF in healthy individuals. With these limitations in mind, immersive virtual reality (VR)-based assessments of EF have garnered interest because of their potential to increase test sensitivity, ecological validity, and neuropsychological assessment accessibility.

OBJECTIVE

This systematic review aims to explore the literature on immersive VR assessments of EF focusing on (1) EF components being assessed, (2) how these assessments are validated, and (3) strategies for monitoring potential adverse (cybersickness) and beneficial (immersion) effects.

METHODS

EBSCOhost, Scopus, and Web of Science were searched in July 2022 using keywords that reflected the main themes of VR, neuropsychological tests, and EF. Articles had to be peer-reviewed manuscripts written in English and published after 2013 that detailed empirical, clinical, or proof-of-concept studies in which a virtual environment using a head-mounted display was used to assess EF in an adult population. A tabular synthesis method was used in which validation details from each study, including comparative assessments and scores, were systematically organized in a table. The results were summed and qualitatively analyzed to provide a comprehensive overview of the findings.

RESULTS

The search retrieved 555 unique articles, of which 19 (3.4%) met the inclusion criteria. The reviewed studies encompassed EF and associated higher-order cognitive functions such as inhibitory control, cognitive flexibility, working memory, planning, and attention. VR assessments commonly underwent validation against gold-standard traditional tasks. However, discrepancies were observed, with some studies lacking reported a priori planned correlations, omitting detailed descriptions of the EF constructs evaluated using the VR paradigms, and frequently reporting incomplete results. Notably, only 4 of the 19 (21%) studies evaluated cybersickness, and 5 of the 19 (26%) studies included user experience assessments.

CONCLUSIONS

Although it acknowledges the potential of VR paradigms for assessing EF, the evidence has limitations. The methodological and psychometric properties of the included studies were inconsistently addressed, raising concerns about their validity and reliability. Infrequent monitoring of adverse effects such as cybersickness and considerable variability in sample sizes may limit interpretation and hinder psychometric evaluation. Several recommendations are proposed to improve the theory and practice of immersive VR assessments of EF. Future studies should explore the integration of biosensors with VR systems and the capabilities of VR in the context of spatial navigation assessments. Despite considerable promise, the systematic and validated implementation of VR assessments is essential for ensuring their practical utility in real-world applications.

Exploring medical students' perceptions of individual and group-based clinical reasoning with virtual patients: a qualitative study

BACKGROUND

Virtual Patients are computer-based simulations used to teach and evaluate patient interviews, medical diagnoses, and treatment of medical conditions. It helps develop clinical reasoning skills, especially in undergraduate medical education. This study aimed to and investigate the medical students' perceptions of individual and group-based clinical reasoning and decision-making processes by using Virtual Patients.

METHODS

The study group comprised 24 third-year medical students. Body Interact® software was utilized as a VP tool. The students' readiness and the courses' learning goals were considered when choosing the scenarios. Semi-structured interview forms were employed for data collection. MAXQDA 2020 qualitative analysis software was used to analyze the data. The students' written answers were analyzed using content analysis.

RESULTS

The participants perceived individual applications as beneficial when making clinical decisions with Virtual Patients, but they suggested that group-based applications used with the same cases immediately following individual applications were a more appropriate decision-making method. The results indicated that students learn to make decisions through trial and error, based on software scoring priorities, or using clinical reasoning protocols.

CONCLUSION

In group-based reasoning, the discussion-conciliation technique is utilized. The students stated that the individual decision-making was advantageous because it provided students with the freedom to make choices and the opportunity for self-evaluation. On the other hand, they stated that the group based decision-making process activated their prior knowledge, assisted in understanding misconceptions, and promoted information retention. Medical educators need to determine the most appropriate method when using Virtual Patients, which can be structured as individual and/or group applications depending on the competency sought.

PhyLab - a virtual reality laboratory for experiments in physics: a pilot study on intervention effectiveness and gender differences

Introduction

New technologies have great potential to facilitate students' understanding and appreciation of one of the most abstract and challenging school subjects - physics. This study aimed to examine the effects of a game-based virtual reality teaching method on secondary school students' self-beliefs, interest, and performance in physics through a quasi-experimental design using pre- and post-test data. The evaluation is based on the systemic actiotope model that explains a person's goal-oriented actions by an interplay of their environment, action repertoire (i.e., students' performance and interest in physics), and subjective action space (i.e., students' self-efficacy, self-concept, and implicit theories regarding physics).

Method

A game-based virtual reality App to be used with Google cardboards was developed containing 10 teaching units from the secondary school physics class curriculum. Participants in the control group were taught using traditional teaching methods, while students in the experimental group went through the VR with the teacher and conducted the prepared VR experiments in addition to the traditionally presented content. Three tests measured students' physics performance during the semester. In addition, students answered questionnaires assessing their interest, self-efficacy, self-concept, and entity implicit theories regarding physics before and after the intervention, resulting in a Pretest-Posttest Control Group Design.

Results

There were no significant differences between the control and experimental group in test scores on the first and second tests but compared to the control group, the experimental group achieved higher scores on the third test. In addition, the results indicate differential effects of the game-based virtual reality teaching method on students' interest and self-efficacy regarding physics to the advantage of students identifying as male, but no effects on students' self-concept, and entity implicit theories regarding physics.

Discussion

The results of our pilot study suggest that incorporating innovative didactic methods into secondary school physics classes could potentially contribute to higher performance in and motivation for physics during this crucial period of adolescence when students develop educational and career aspirations. However, game-based virtual reality teaching methods seem to favor students identifying as male, which should be considered in their development and presentation. Other practical implications for practitioners and researchers are discussed.

Acceptability Assessment of an Executive Function Training Game FISHERMAN for Older Adults

Objective: In recent years, an increasing number of gamification tools have been developed for older adults; however, few studies have explored the acceptability of these tools after initial use and sustained use in older adults. In the current study, we focus on "FISHERMAN," an executive function training game containing a cognitive game and an exergame, with the aim of investigating and comparing the acceptability of both versions of "FISHERMAN" after initial use and 3 months of sustained use in older adults. Materials and Methods: Seventy-six older adults were randomly assigned to the cognitive game training group or the exergame training group. Participants completed two 1-hour sessions per week for 12 weeks. Acceptability was evaluated through a validated, 7-point, self-rating, Interactive Technology Art Installation Technology Acceptance Model Questionnaire after the first and last training sessions, with higher ratings representing higher acceptability. The questionnaire included 22 items and 9 acceptability dimensions: usage behavior, intention to use, perceived usefulness, perceived ease of use, perceived playfulness, subjective norm, image, output quality, and result demonstrability. Descriptive statistics were conducted to evaluate acceptability after initial and sustained use. Two-way (time: initial use and sustained use; group: cognitive game group and exergame group) repeated ANOVAs were conducted to investigate the differences in acceptability. Post hoc, within-group, paired-sample t test analyses were performed to evaluate changes in game acceptability for each group over time. Results: After initial use and 3 months of sustained use, the average scores for overall acceptability and individual dimensions exceeded 5.5 of 7 points in both groups. The two groups presented different changes from initial use to sustained use. The overall acceptability, usage behavior, perceived usefulness, and perceived ease of use were significantly improved after training within the cognitive game group, while perceived playfulness was significantly reduced within the exergame group. Conclusions: The current study provided preliminary evidence that older adults had high acceptability for both the cognitive game and exergame versions of "FISHERMAN." After sustained use, acceptability of the cognitive game increased and acceptability of the exergame decreased, highlighting the importance of assessing game acceptability after initial and sustained use.

The effectiveness of badging systems in engaging, motivating, and incentivizing students in the mastery of nursing licensure materials

INTRODUCTION

Integrating gamification methods into undergraduate nursing programs has prepared students to pass the nursing comprehensive predictor test and the licensure examination.

LITERATURE REVIEW

Research demonstrates that the motivational factors of game elements like badging and leaderboards are of great value and utility to student engagement and motivation. The badges symbolize achievement, authority, and belonging, whereas leaderboards rank students based on different levels of course engagement.

DISCUSSION

This paper explores the benefits, challenges, and strategies of incorporating digital badges and leaderboards in the undergraduate program. Immersion courses preparing students for professional practice are usually one of the last didactic courses offered in the undergraduate curriculum, designed to integrate all knowledge gained from the nursing program.

IMPLICATIONS FOR AN INTERNATIONAL AUDIENCE

The digital badging system can encourage nurse educators globally to engage, motivate, and power students to achieve professional goals. Furthermore, nursing programs worldwide can benefit from adding digital badges and leaderboards to final semester preparatory courses or any nursing course with the same emphasis.

CONCLUSIONS

Digital badges and leaderboards engage and motivate students to integrate knowledge and skills learned in the nursing program and successfully master nurse licensure materials.

Serious gaming for graduates employability enhancement

Higher Education Institutions (HEIs) are blamed for being insouciant about the business world and not efficiently steeling students with employment abilities. As a reply to this exigency from business owners, HEIs have started to show commitment to graduate employability through developing and adopting new educational material, such Serious Games (SGs), to help students acquire these soft skills. This paper explores the students' perceptions of the significance of SGs on soft skills and therefore boosting graduate employability. We carried out a quantitative and qualitative study with 322 students from business colleges in the aim to focus on the impact of user experience in SGs on critical thinking and teamwork. The results highlight the strong influence of SGs to acquire these soft skills.

Gamified versus non-gamified online educational modules for teaching clinical laboratory medicine to first-year medical students at a large allopathic medical school in the United States

BACKGROUND

Medical educators seek innovative ways to engage learners efficiently and effectively. Gamification has been explored as one way to accomplish this feat; however, questions remain about which contexts gamification would be most useful. Time constraints and student interest present major barriers for teaching laboratory medicine to students. This study aims to compare two versions of an interactive online module, one gamified and one not, for teaching laboratory medicine concepts to pre-clinical medical students.

METHODS

First-year medical students reviewed either a gamified or non-gamified version of an interactive online module in preparation for an in-person flipped classroom session on Laboratory Medicine. Learning theory guided the design of the modules and both contained identical content, objectives, and structure. The "gamified" module included the additional elements of personalization, progress meters, points, badges, and story/role play. After reviewing the module, students completed an anonymous knowledge check and optional survey.

RESULTS

One hundred seventy-one students completed the post module knowledge check as assigned (82 gamified, 89 non-gamified). Knowledge check scores were higher for the students who reviewed the gamified module (p < 0.02), corresponding to an effect size of 0.4 for the gamified module. Eighty-one students completed optional post-module surveys (46 gamified, 35 non-gamified). Instructional efficiency was calculated using task difficulty questions and knowledge check scores, and the resulting instructional efficiency was higher for the gamified module. There was no significant difference in the student-reported time required to complete the modules. Additionally, both versions of the module were well received and led to positive ratings related to motivation and confidence. Finally, examination of open-ended survey results suggested that the addition of game elements added value to the gamified module and enhanced engagement and enjoyment.

CONCLUSIONS

In this setting, the addition of gamification to an interactive online module enhanced learning outcome, instructional efficiency, student engagement and enjoyment. These results should inspire further exploration of gamification for teaching Laboratory Medicine concepts to pre-clinical medical students.

Gamification as an Educational Approach for Oncological Patients: A Systematic Scoping Review

BACKGROUND

Education plays a pivotal role in the care of oncological patients, reducing health costs, hospital readmission, and disease relapses. Education can be supportive in achieving multiple outcomes, improving symptom control and quality of life. A new approach is emerging in patient education: gamification. Gamification was defined as the "use of game elements in non-game contexts", including the application of games in serious contexts. The aim of this review is to explore the use of gamification in the oncology setting.

METHODS

A systematic scoping review was conducted in the MEDLINE, CINAHL, PsychINFO, Embase, Scopus, and Cochrane Library databases using the JBI guidelines.

RESULTS

The 13 included reports were critically appraised by two reviewers independently. It seems that gamification could be effective both in prevention and cancer treatments. Gamification also seems to improve chemotherapy-induced nausea and vomiting management, quality of life, and reduced anxiety levels in different cancer groups. Moreover, gamification seems effective in improving self-care in cancer patients, regardless of gender, age, and ethnicity.

CONCLUSIONS

Gamification improves patient engagement and biopsychosocial outcomes and could represent a valid approach to cancer patient education; however, it is not a substitute for healthcare professionals, who remain the leaders in the education process.

Nurseped: educational technology for safety in the management of intravenous antibiotics in pediatrics

OBJECTIVE

to develop and validate the content of a serious game on the safe management of intravenous medications in pediatrics.

METHOD

methodological study for the development and content validation of an educational technology. The cases and challenges of the serious game were developed based on a literature review and validated by 11 nurses with training and experience in the area. Content validity and agreement indices were adopted to analyze agreement and internal consistency (minimum of 0.8).

RESULTS

the content is based on the main antibiotics used in the clinical management of infections in hospitalized children and patient safety. Absolute agreement was obtained in 60 of the 61 items evaluated, and the minimum obtained was 0.82 in the content validation index and 0.80 in agreement. Adjustments were suggested by experts in the response statement for a specific case and implemented to improve the quality of the technology content.

CONCLUSION

the content of the serious game Nurseped was validated by nurse experts in child health regarding clinical cases, question statements and multiple-choice answers, in addition to feedback that presents the user with an evidence-based answer after getting the challenge right or wrong.

Prototyping Process and Usability Testing of a Serious Game for Brazilian Children With Type 1 Diabetes

This study aims to describe the prototype development and testing of a serious game designed for Brazilian children with diabetes. Following an approach of user-centered design, the researchers assessed game's preferences and diabetes learning needs to develop a Paper Prototype. The gameplay strategies included diabetes pathophysiology, self-care tasks, glycemic management, and food group learning. Diabetes and technology experts (n = 12) tested the prototype during audio-recorded sessions. Next, they answered a survey to evaluate the content, organization, presentation, and educational game aspects. The prototype showed a high content validity ratio (0.80), with three items not achieving the critical values (0.66). Experts recommended improving the game content and food illustrations. This evaluation contributed to the medium-fidelity prototype version, which after testing with diabetes experts (n = 12) achieved high content validity values (0.88). One item did not meet the critical values. Experts suggested increasing the options of outdoor activities and meals. Researchers also observed and video-recorded children with diabetes (n = 5) playing the game with satisfactory interaction. They considered the game enjoyable. The interdisciplinary team plays an important role guiding the designers in the use of theories and real needs of children. Prototypes are a low-cost usability and a successful method for evaluating games.

Learning Landscape in Gamification: The Need for a Methodological Protocol in Research Applications

In education, the term "gamification" refers to of the use of game-design elements and gaming experiences in the learning processes to enhance learners' motivation and engagement. Despite researchers' efforts to evaluate the impact of gamification in educational settings, several methodological drawbacks are still present. Indeed, the number of studies with high methodological rigor is reduced and, consequently, so are the reliability of results. In this work, we identified the key concepts explaining the methodological issues in the use of gamification in learning and education, and we exploited the controverses identified in the extant literature. Our final goal was to set up a checklist protocol that will facilitate the design of more rigorous studies in the gamified-learning framework. The checklist suggests potential moderators explaining the link between gamification, learning, and education identified by recent reviews, systematic reviews, and meta-analyses: study design, theory foundations, personalization, motivation and engagement, game elements, game design, and learning outcomes.

Effectiveness of gamification and selection of appropriate teaching methods of creativity: Students' perspectives

Complex creativity and multiple learning objectives often require combining several teaching methods, and gamification may be an effective teaching strategy for enhancing learning. However, few studies have examined the combined effects of implementing gamification and multiple teaching methods in a course from students' perspectives. Therefore, this study implemented gamification and six teaching methods of enhancing college students' creativity in university creativity and innovation course in November and December 2021 and aimed to examine the effects on their creativity, collaboration, and communication skills and used the Analytical Hierarchy Process to identify more effective teaching methods corresponding to the learning objectives from students' perspectives. The results showed that students perceive that gamification could stimulate their motivation, attitudes, and interest in learning and enhance their creativity, collaboration, and communication skills. Furthermore, Mandala thinking was the most effective teaching method for the overall goal. In contrast, the most effective teaching methods for the creativity, collaboration, and communication skills learning objectives were the SCAMPER technique, balloon competition, and Mandala thinking, respectively. The results provide essential references for selecting effective teaching methods that meet the teaching objectives.

Rehearsal-based digital serious boardgame versus a game-free e-learning tool for anatomical education: Quasi-randomized controlled trial

Serious games may resolve problems relating to low motivation in complex medical topics such as anatomy. However, they remain relatively novel introductions to the science of learning, and further research is required to ascertain their benefits. This study describes the overall development and testing of a digital serious boardgame designed to facilitate the rehearsal of musculoskeletal anatomy based on self-determination theory with considerations for the psychological state of Flow. It was hypothesized that students assigned to the intervention game condition would attain higher Flow scores, a measure of engagement and intrinsic motivation, than students assigned to the game-free control, and that the intervention condition would report either superior or non-superior, but not inferior, scores on a surprise recall test. A total of 36 second-year undergraduate medical students participated in the quasi-randomized controlled trial, where the intervention groups went first and randomly drew questions that were mirrored into the control groups. All students were administered an identical 10-question baseline assessment before their interventions, the Short Flow Scale immediately after, and a surprise test four-to-six weeks later. Independent samples t-tests indicated that students of both conditions were of similar baseline knowledge (t = 0.7, p = 0.47), significantly higher Flow scores in the game condition (t = 2.99, p = 0.01), and no significant differences between surprise test scores (t = -0.3, p = 0.75). The game appears to be an appropriate game-based tool for student rehearsal of anatomical education, stemming from a strong theoretical base that facilitates high engagement and intrinsic motivation.

Factors Influencing Non-Fungible Tokens (NFT) Game Engagement during the COVID-19 pandemic: The Theory of Planned Behavior (TPB) and Hedonic Motivation System Adoption Model (HMSAM) Approach

The prominent form of Non-Fungible Token (NFT) is found in the gaming industry. NFT games received immense attention during the COVID-19 pandemic because of their play-to-earn model. NFT gamers can enjoy and increase their finances in their spare time. Hence, the researchers utilized Structural Equation Modeling (SEM) to investigate the intention and immersive behaviors of 1082 respondents. The modified framework from the Theory of Planned Behavior (TPB) and Hedonic Motivation System Adoption Model (HMSAM) underwent SEM tests. These theories and methods were used to analyze relationships among hypotheses and assess factors influencing NFT game engagement. The results showed that hedonic motivation produced positive and significant influences on perceived usefulness, curiosity, joy, attitude, subjective norms, and perceived behavioral control. Subjective norms significantly influenced perceived ease of use. In due course, perceived ease of use yielded positive and significant effects on perceived usefulness, joy, attitude, and perceived behavioral control. Moreover, perceived usefulness, curiosity, joy, attitude, and perceived behavioral control had significant positive effects on behavioral intention. In addition, perceived usefulness, curiosity, joy, and attitude significantly and positively affected immersion. Meanwhile, only four hypotheses were not supported by the study. These findings were translated into theoretical and managerial implications to contribute to the academe given the strong the change of behavior of users towards NFT games during the pandemic; gaming industry since they will be able to develop, improve and create a new ecosystem in the gaming space, and NFT stakeholders since they will benefit from the development that will influence this study.

Serious game as oral histology learning strategy for undergraduate dental students; crossover randomized controlled trial

BACKGROUND

Oral histology is perceived by dental students as a challenging subject and often struggle to recognize the long-term relevance of understanding the cells and tissues at the microscopic level. Serious games have been reported to have a positive effect on student cognitive skills and learning motivation. However, there is still a limited amount of research supporting the effectiveness of serious games as a learning method in dentistry. The present study aimed to evaluate the impact of serious game of HistoRM as a complementary learning strategy for oral histology.

METHODS

The study design was a crossover randomized controlled trial. A total of 74 first year dental students of Universitas Indonesia participated in the study and divided into 2 groups. Study intervention included HistoRM game for 3 days followed by a combination of HistoRM and script-based handouts for another 4 days. The groups represented different intervention sequences. Evaluation was performed using pre-test, post-test on day 3 and 7 and a questionnaire.

RESULTS

The data showed significant improvement of student cognitive skills (p < 0.001) and it was influenced by the number of game missions completed. Students who completed the whole 15 missions have a higher day-7 post-tests scores (p = 0.03). Perception of dental students on HistoRM was positive in all domains tested, the learning content, games and learning experience domains. Immediate feedback given after each gameplay helped the students understand the subject matters.

CONCLUSION

Serious game of HistoRM effectively improved students' understanding of oral histology learning outcome and provided more interesting learning experiences. This innovative learning can be recommended as a complementary learning strategy of oral histology for dental students.

A Novel Mobile App for Personalized Dietary Advice Leveraging Persuasive Technology, Computer Vision, and Cloud Computing: Development and Usability Study

BACKGROUND

The Australian Dietary Guidelines (ADG) translate the best available evidence in nutrition into food choice recommendations. However, adherence to the ADG is poor in Australia. Given that following a healthy diet can be a potentially cost-effective strategy for lowering the risk of chronic diseases, there is an urgent need to develop novel technologies for individuals to improve their adherence to the ADG.

OBJECTIVE

This study describes the development process and design of a prototype mobile app for personalized dietary advice based on the ADG for adults in Australia, with the aim of exploring the usability of the prototype. The goal of the prototype was to provide personalized, evidence-based support for self-managing food choices in real time.

METHODS

The guidelines of the design science paradigm were applied to guide the design, development, and evaluation of a progressive web app using Amazon Web Services Elastic Compute Cloud services via iterations. The food layer of the Nutrition Care Process, the strategies of cognitive behavioral theory, and the ADG were translated into prototype features guided by the Persuasive Systems Design model. A gain-framed approach was adopted to promote positive behavior changes. A cross-modal image-to-recipe retrieval model under an Apache 2.0 license was deployed for dietary assessment. A survey using the Mobile Application Rating Scale and semistructured in-depth interviews were conducted to explore the usability of the prototype through convenience sampling (N=15).

RESULTS

The prominent features of the prototype included the use of image-based dietary assessment, food choice tracking with immediate feedback leveraging gamification principles, personal goal setting for food choices, and the provision of recipe ideas and information on the ADG. The overall prototype quality score was "acceptable," with a median of 3.46 (IQR 2.78-3.81) out of 5 points. The median score of the perceived impact of the prototype on healthy eating based on the ADG was 3.83 (IQR 2.75-4.08) out of 5 points. In-depth interviews identified the use of gamification for tracking food choices and innovation in the image-based dietary assessment as the main drivers of the positive user experience of using the prototype.

CONCLUSIONS

A novel evidence-based prototype mobile app was successfully developed by leveraging a cross-disciplinary collaboration. A detailed description of the development process and design of the prototype enhances its transparency and provides detailed insights into its creation. This study provides a valuable example of the development of a novel, evidence-based app for personalized dietary advice on food choices using recent advancements in computer vision. A revised version of this prototype is currently under development.

A Review of Serious Gaming as an Intervention for HIV Prevention

PURPOSEOF REVIEW

Young people face the highest number of new HIV infections globally. With today's increasing access to smartphones, serious games have been viewed as an effective means of improving knowledge and behavioral outcomes. This systematic review describes current HIV prevention serious games and their relationship with HIV-related knowledge and behavioral outcomes.

RECENT FINDINGS

A search of HIV prevention serious games was conducted using PubMed, CINAL, IEEE, Web of Science, and Google Scholar. A total of 31 papers were identified, which consist of 20 studies and 11 protocols. Results for knowledge, attitudes, intentions, and behaviors were mixed. Two interventions reported improvement in PrEP usage and optimal dosing. Gaming appears to be a viable and engaging method to improve knowledge, attitudes, and behavioral outcomes to promote HIV prevention among diverse groups of adolescents and young adults globally. However, additional research is needed to understand how to implement this modality effectively.

The REThink Online Therapeutic Game: A Usability Study

BACKGROUND

Children and adolescents' help-seeking behaviors are often limited by fear, uncertainty, and stigma, as well as challenges with finding the right intervention, help, and a lack of familiarity with the process. A promising direction for the development of therapeutic interventions targeted at children is embedding them into gamified interventions, known as therapeutic or serious games. The aim of this paper is to describe the protocol of the beta REThink therapeutic game and to evaluate the usability of the game in a sample of children and adolescents.

METHODS

The study was delivered in schools, where 137 children and adolescents aged between 9 and 16 years old played the levels of the REThink game, followed by filling in the usability questionnaire.

FINDINGS

The results show above average evaluations for all levels of the game, for every dimension evaluated, namely presence/immersion, enjoyment, learning effectiveness, narratives, goal clarity, adequacy of learning material, and motivation. This study contributes to the literature on the usability of cognitive behavioral therapy-based therapeutic games for improvements in the emotion regulation abilities of children and adolescents, which can guide researchers interested in testing the REThink game in different protocols, as well to encourage its use by mental health specialists and parents.

Educational Concepts of Digital Competence Development for Older Adults-A Scoping Review

The digital transformation of healthcare and nursing is becoming increasingly important due to demographic change and the growing shortage of skilled workers. In order to ensure the participation of senior citizens in digital assistive technologies, educational concepts and support services are needed to promote digital skills in older adults. Therefore, the specific needs and prerequisites of this target group have to be taken into consideration. This paper asks how educational programs for the support of digital competences of older adults are designed and implemented. A scoping review was conducted to systematically extract existing findings from the literature. Four databases (Cinahl, PubMed, Web of Science Social Sciences Citation Index (SSCI), ERIC) were searched using an exploratory strategy to identify studies that address educational concepts promoting digital competences for older adults. A total of 47 publications were included in the qualitative analysis and show a variety of strategies to deal with the promotion of digital competences for elderly people. In conclusion, programs dealing with the promotion of digital competences for elderly people should be flexibly adapted to the target group with its specific needs and challenges such as fears, lack of previous experience, or physical limitations. For successful implementation, social support is of outstanding importance.

Shall we play together? Game-based learning for engagement and classroom climate in Spanish socially deprived communities

Purpose

The purpose of this study is to analyze the effects of a game-based learning (GBL) program on the classroom climate and engagement of high schools in socially deprived communities in Spain.

Methods

The study included 277 students from two secondary schools located in Southern Spain, situated in Zones in Need of Social Transformation. Sampling was non-probabilistic and accidental, based on the accessibility of the school and the willingness of the management and teaching staff to participate in the GBL program. The study employed a control group and two experimental groups (cooperative games group only and cooperative and competitive games group) to compare pre-test and post-test data in both groups. The Brief Class Climate Scale and Engagement Inventory, validated in academic literature, were used as assessment instruments.

Results

The study used a series of ANOVA tests to compare the experimental groups with the control group. The results indicated statistically significant changes in all study variables. In all cases, the experimental groups demonstrated greater benefits than the control group.

Discussion and conclusion

The study findings reveal that games can provide significant benefits to students, regardless of whether they are cooperative or competitive. The study provides evidence of the benefits of GBL in high schools located in socially deprived communities in Spain.

Development and Contribution of a Serious Game to Improve Nursing Students' Clinical Reasoning in Acute Heart Failure: A Multimethod Study

Clinical reasoning is essential for nurses and nursing students to recognize and intervene when hospitalized patients present acute heart failure. Serious games are digital educational interventions that could foster the development of clinical reasoning through an engaging and intrinsically motivating learning experience. However, elements from a playful approach (eg, rewards, narrative elements) are often absent or poorly integrated in existing serious games, which may limit their contribution to learning. Thus, we developed and studied the contribution of a novel serious game on nursing students' engagement, intrinsic motivation, and clinical reasoning in the context of acute heart failure. We adopted a multimethod design and randomized 28 participants to receive two serious game prototypes in a different sequence, one that fully integrated elements of a playful approach (SIGN@L-A) and one that offered only objectives, feedback, and a functional aesthetic (SIGN@L-B). Through self-reported questionnaires, participants reported higher levels of engagement and intrinsic motivation after using SIGN@L-A. However, negligible differences in clinical reasoning scores were found after using each serious game prototype. During interviews, participants reported on the contribution of design elements to their learning. Quantitative findings should be replicated in larger samples. Qualitative findings may guide the development of future serious games.

Effects of a collaborative and gamified online learning methodology on class and test emotions

This study examines the influence of students' individual attitude and social interactions on participation in collaborative and gamified online learning activities, as well as the influence of participating in those activities on students' online class- and test-related emotions. Based on a sample of 301 first year Economics and Law university students and using the Partial Least Squares-Structural Equation Modelling approach, all the relationships among first-order and second-order constructs included in the model are validated. The results support all the hypotheses studied, confirming the positive relationship that both students' individual attitude and social interactions have on participation in collaborative and gamified online learning activities. The results also show that participating in those activities is positively related with class- and test-related emotions. The main contribution of the study is the validation of the effect of collaborative and gamified online learning on university students' emotional well-being through the analysis of their attitude and social interactions. Moreover, this is the first time in the specialised learning literature that students' attitude is considered as a second-order construct operationalised by three factors: the perceived usefulness that this digital resource brings to the students, the entertainment that this digital resource brings to the students, and the predisposition to use this digital resource among all those available in online training. Our findings aim to shed light for educators when preparing and designing computer mediated and online teaching programs that seek to generate positive emotions as a motivation for students.

Development and Evaluation of a Serious Game Application to Engage University Students in Critical Thinking About Health Claims: Mixed Methods Study

BACKGROUND

Misleading health claims are widespread in the media, and making choices based on such claims can negatively affect health. Thus, developing effective learning resources to enable people to think critically about health claims is of great value. Serious games can become an effective learning resource in this respect, as they can affect motivation and learning.

OBJECTIVE

This study aims to document how user insights and input can inform the concept and development of a serious game application in critical thinking about health claims in addition to gathering user experiences with the game application.

METHODS

This was a mixed methods study in 4 successive phases with both qualitative and quantitative data collected in the period from 2020-2022. Qualitative data on design and development were obtained from 4 unrecorded discussions, and qualitative evaluation data were obtained from 1 recorded focus group interview and 3 open-ended questions in the game application. The quantitative data originate from user statistics. The qualitative data were analyzed thematically, and user data were analyzed using nonparametric tests.

RESULTS

The first unrecorded discussion revealed that the students' (3 participants') assessment of whether a claim was reliable or not was limited to performing Google searches when faced with an ad for a health intervention. On the basis of the acquired knowledge of the target group, the game's prerequisites, and the technical possibilities, a pilot of the game was created and reviewed question by question in 3 unrecorded discussions (6 participants). After adjustments, the game was advertised at the Oslo Metropolitan University, and 193 students tested the game. A correlation (r=0.77; P<.001) was found between the number of replays and total points achieved in the game. There was no demonstrable difference (P=.07) between the total scores of students from different faculties. Overall, 36.3% (70/193) of the students answered the evaluation questions in the game. They used words such as "fun" and "educational" about the experiences with the game, and words such as "motivating" and "engaging" related to the learning experience. The design was described as "varied" and "user-friendly." Suggested improvements include adding references, more games and modules, more difficult questions, and an introductory text explaining the game. The results from the focus group interview (4 participants) corresponded to a large extent with the results of the open-ended questions in the game.

CONCLUSIONS

We found that user insights and inputs can be successfully used in the concept and development of a serious game that aims to engage students to think critically about health claims. The mixed methods evaluation revealed that the users experienced the game as educational and fun. Future research may focus on assessing the effect of the serious game on learning outcomes and health choices in randomized trials.

Who likes to learn new things? How Gamification User Types and Satisfaction but not the frustration of basic psychological needs explain the preference for learning new things

The concept of gamification, the use of game elements to improve performance in real-life tasks (such as learning), has been investigated thoroughly. Yet, the results are mixed with a tendency to be cautiously optimistic when it comes to how one can benefit from an application of gamification in education. The research shows that two factors are responsible for the unclear relationship: the context and gamification and the individual characteristics of the users. The purpose of this study was to investigate further the latter one. We tested the relationship between the Self Determination Theory (Basic Psychological Needs) and Gamification motives with a preference for learning new things (PLNT). We hypothesised a mediation effect between the needs and PLNT via gamification motives. Eight hundred seventy-three participants took part in the study, aged between 18 and 24 years old, 34 % were women. We employed two standardised instruments: The Basic Psychological Need Satisfaction and Frustration Scale and The Gamification User Types Hexad Scale, and three questions to measure PLNT. The results showed that only autonomy satisfaction and competence satisfaction predict the PLNT. Furthermore, gamification motives did mediate the relationship between the need and the PLNT. Still, in a limited way - three motives constructed a meta-motive (related to reward, autonomy and purpose) and mediated only the relationship between competence satisfaction and the PLNT. In contrast, the need for autonomy satisfaction directly predicted the PLNT. Whether certain needs and motivations help students learn new things or approach learning new things with keen interest remains an open question. Our study suggests that some needs and motivations might be more related to PLNT, but it may be so for reasons we were unable to test for, for instance, due to adaptive processes. This would, in turn, suggest that, much like in the case of values and their relation to happiness, it is not only the profile of needs and motivations that shape students' learning experience but rather the opportunity created for those students (by their teachers and by the system) to follow the needs and motivations they naturally have.

Latent factors on the design and adoption of gamified apps in primary education

The main objective of this research is to determine the perception of teachers about the elements that increases the educational effectiveness of gamified apps in primary education. A methodology based on an importance-performance analysis was daeveloped, using a structural equations model to calcuate the degree of importance of each variable. The sample was formed of 212 Spanish teachers with experience using educational apps in the teaching-learning process. Six categories were identified as precursors of educational effectiveness: (1) curriculum connection, (2) feedback and operational experience, (3) assessment and learning analytics, (4) sustainability (Protection Personal data), (5) equal access and (6) flow. These six categories enhance the three traditional areas of gamification intervention: cognitive, emotional and social. In this sense, the design and adoption of an educational gamified app should: (1) establish a clear link between the game and curricular content and competence development; (2) promote self-regulated learning through individual and collaborative activities; (3) offer adapted learning by integrating differentiated personalized learning pathways; (4) integrate learning analytics that can be consulted by teacher, student and family; (5) comply with data protection regulation and promote a safe, sustainable and ethical use of the information generated; (6) take into account different levels of functional diversity. When the gamified app design incorporates these attributes, primary education teachers perceive that such resources can be integrated effectively into the teaching-learning processes.

Mobile apps used for people living with multiple sclerosis: A scoping review

BACKGROUND

Multiple Sclerosis (MS) is a chronic neurodegenerative disorder. People living with MS (plwMS) require long-term, multidisciplinary care in both clinical and community settings. MS-specific mHealth interventions have advanced in the form of clinical treatments, rehabilitation, disease monitoring and self-management of disease. However, mHealth interventions for plwMS appear to have limited proof of clinical efficacy. As native mobile apps target specific mobile operating systems, they tend to have better interactive designs leveraging platform-specific guidelines. Thus, to improve such efficacy, it is pivotal to explore the design characteristics of native mobile apps used for plwMS.

OBJECTIVES

This study aimed to explore the design characteristics of native mobile apps used for adults living with MS in academic settings.

METHODS

A scoping review of studies was conducted. A literature search was performed through PubMed, CINAHL, MEDLINE and Cochrane Library. Per native mobile apps, characteristics, persuasive technology elements and evaluations were summarized.

RESULTS

A total of 14 native mobile apps were identified and 43% of the identified apps were used for data collection (n=6). Approximately 70% of the included apps involved users (plwMS) whilst developing (n=10). A total of three apps utilized embedded sensors. Videos or photos were used for physical activity interventions (n=2) and gamification principles were applied for cognitive and/or motor rehabilitation interventions (n=3). Behavior change theories were integrated into the design of the apps for fatigue management and physical activity. Regarding persuasive technology, the design principles of primary support were applied across all identified apps. The elements of dialogue support and social support were the least applied. The methods for evaluating the identified apps were varied.

CONCLUSION

The findings suggest that the identified apps were in the early stages of development and had a user-centered design. By applying the persuasive systems design model, interaction design qualities and features of the identified mobile apps in academic settings were systematically evaluated at a deeper level. Identifying the digital functionality and interface design of mobile apps for plwMS will help researchers to better understand interactive design and how to incorporate these concepts in mHealth interventions for improvement of clinical efficacy.

Presence in video games: A systematic review and meta-analysis of the effects of game design choices

Sense of presence is a widely assessed dimension of video game player experience. A systematic literature review and a meta-analysis were conducted to provide a more comprehensive view of the elements of game design that have an effect on the sense of presence, as well as its different dimensions studied and assessment techniques. The review revealed that many major categories of game design aspects were well represented. The meta-analysis revealed that several game design factors have significant effects on different dimensions of presence. The largest revealed effects were that playing games with a head-mounted display and motion controller rather than a monitor display and non-motion controller has a large effect on global presence. Also, playing with human co-players rather than computer-controlled co-players and playing cooperatively rather than competitively have a very large and large effect on social presence, respectively. Implications for future research are discussed, such as investigating the effects of design factors on presence in a more targeted manner, systematically assessing presence with its most relevant sub-dimensions, and using more similar rating scales. Design recommendations, with their expected impact on players' sense of presence, are proposed.

Gamification and Game Based Learning for Vocational Education and Training: A Systematic Literature Review

Games have been used as a learning tool for centuries. Gamification and game-based learning are becoming more prominent in educational settings for several reasons. When it comes to learning, being focused and immersed can massively improve a student's experience. The purpose of this study is to map the emerging trends of gamification and game-based learning (GBL) in the Vocational and Education Training (VET) sector. For this purpose, a Systematic Literature Review was conducted through the three most relevant scientific databases - Web of Science, Scopus, ScienceDirect, and PubMed with Google Scholar as a supporting database. The obtained sample was further selected following the PRISMA guidelines with screening and eligibility processes conducted based on inclusion criteria that were defined with consideration to the research's aim. This review comprised seventeen studies. The findings revealed a growing interest in the Asian continents in research from 2020 onwards. Furthermore, most of the study is centred on vocational schools and colleges in the engineering and healthcare fields. According to the overview, the digital learning platform and simulation technology are the most promising tools used in the research. The findings support the conclusion that gamification and game-based learning can improve academic performance, engagement, and motivation in vocational education learners. As a result, this study suggests that more research is needed to determine the gamification strategies that are most suited for vocational education and learning.

Inaugural Pan-Canadian RADGames: Results From a Successful Approach to Radiology Education for Medical Students

RATIONALE AND OBJECTIVES

A goal in radiology undergraduate medical education is to improve exposure to the field. In 2022, the Canadian Association of Radiologists' Medical Student Network hosted for the first time "RADGames," an interactive image interpretation contest for medical students across Canada. This program was aimed to spark interest in radiology and improve students' image interpretation skills through gamification with expert guidance.

MATERIALS AND METHODS

Volunteers from Radiology Interest Groups in Canadian medical schools set up a virtual event for the competition using breakout rooms and a quiz platform. Participant recruitment was through social media and advertisement by medical student associations. Participants were surveyed anonymously for feedback following the event. Data about previous exposure to and knowledge of radiology, and an evaluation of the event including self-perceived impact on participants' understanding of the field were collected.

RESULTS

Eighty seven medical students from 15 of Canada's 17 medical schools competed against one another virtually. Forty seven (54%) responded to the post-event evaluation survey. All responses about the event itself were favourable. Respondents overwhelmingly indicated that RADGames increased their interest in radiology (38, 81%), their understanding of the work of a radiologist (31, 66%) and their knowledge about medical imaging (46, 98%), and improved their confidence in basic imaging interpretation (36, 77%).

CONCLUSION

The Canadian Association of Radiologists' Medical Student Network hosted Canada's first national image interpretation competition for medical students, RADGames. Feedback was overwhelmingly positive, with perceived benefits to participants on their understanding of and interest in radiology.

A scoping review of gamification for mental health in children: Uncovering its key features and impact

Mental health conditions in children and adolescents have wide-ranging effects, limiting opportunities for future productive lives. While there has been an upsurge of interest in using games for learning, gamification to optimize health outcomes is worth reviewing when this approach to address mental health conditions is in its infancy. A literature search was conducted with two hundred and fifteen articles involving participants up to 19 years of age with diagnosable mental health conditions, involving the concept of game design elements to motivate health in the context of comparing gamification and non-gamification approaches were retrieved after employing Boolean operators and pre-determined search strategies. Literature of participants with addiction to alcohol or substance use and organic brain issues were excluded as their mental health recovery differed regardless of gamification impact. Findings, extracted from 8 included articles following rigorous screening and critical appraisal, showed that gamification to relieve mental health symptoms were conducted via mobile devices or computers. Key features of the games involved applications or video where players with mental health conditions took on roles in a virtual world with narratives. Real-life knowledge and skills to manage the symptoms of mental health conditions were learned in the process as players leveled up in the game. Only one study utilized gamification platforms that could detect breathing changes but it was shown to be only helpful towards relief of anxiety symptoms. Nevertheless, the potential for gamification for mental health outcomes remains promising.

A systematic review and meta-analysis of randomized controlled trials on the effect of serious games on people with dementia

BACKGROUND

An increase in dementia prevalence has been accompanied by increasing interest in new rehabilitation methods, such as serious games. Serious games hold the potential to postpone functional and cognitive declines in people with dementia by increasing their independence and engagement; however, the efficacy of serious games remains underexplored. This review was conducted to quantify the effects of serious games in people with dementia, including several newly published trials, with the hopes of contributing to evidence-based practice by offering support for clinical decision-making.

METHODS

Only randomized controlled trials (RCTs) assessing the impacts of game-based intervention programs compared with conventional therapy on cognitive function, instrumental and non-instrumental activities of daily living, or depression among people with dementia were included in this review. Meta-analyses were performed to determine the pooled standardized mean difference (SMD) of each outcome using a random-effects model.

RESULTS

The final search identified 12 studies that met our criteria. Overall, serious games were found to improve cognitive function (pooled SMD: 0.34; 95% CI: 0.07-0.61) and alleviated depression (pooled SMD: -0.131; 95% CI: -1.85 to -0.77) in people with dementia.

CONCLUSIONS

Serious games improve cognitive function and reduce depression in people with dementia. Future studies in this field should aim to evaluate and determine the long-term effect of these games.

The Effects of Sensory Cues on Immersive Experiences for Fostering Technology-Assisted Sustainable Behavior: A Systematic Review

Games are consistently acknowledged as a powerful approach that can significantly impact people’s behavior towards living in a sustainable way. Sensory cues are regarded as influential factors in facilitating immersive experiences in gamified applications to foster sustainable behavior. As our perception of an environment is influenced not only by what we can see but also by additional sensory input such as sound and touch, additional sensory information can be part of the participant’s experience. This study systematically scrutinized game-based applications containing sensory cues to interpret current technology-assisted sustainable behavior development. This study provides a review of the impact of the sensory signals offered by video games, virtual reality, and augmented reality on pro-environmental behavioral intention. This research found that human senses can change the perception of immersion in multiple ways: visual (dimensions, angles, color), auditory (music, dialogue), and haptic, and these can affect sustainable behavior. Thus, we argue that multiple sensory modalities provide more opportunities to influence users to act sustainably. Based on the results, the theoretical contribution of this paper emphasizes the level of immersion, which is closely related to various sensory perceptions, and explains the correlation between them. In terms of industrial applications, it provides game designers, developers of VR and AR applications, and planners of sustainable education guidelines for the adoption of immersive scenarios.

Incorporating fantasy into gamification promotes student learning and quality of online interaction

We used the design-based research approach to test and refine a theoretically grounded goal-access-feedback-challenge-collaboration gamification model. The testbed was a 10-week, university-level e-learning design course offered in two consecutive semesters. In Study 1, we implemented the initial goal-access-feedback-challenge-collaboration model in semester one of the 2020-2021 academic year (N = 26). The aim was to enhance student behavioral engagement in online discussion forums, affective engagement in the class, and learning performance. The results of Study 1 showed that although most participants were engaged in this gamified learning experience during the first two sessions, they gradually lost interest and their participation in online discussions dropped over the next eight weeks. Thus, we introduced a new element, fantasy, into the original model. In Study 2, we tested the effectiveness of the goal-access-feedback-challenge-collaboration-fantasy model on students' learning outcomes in semester two of 2020-2021 (N = 23). The results of Study 2 suggested that, compared to the original model, the goal-access-feedback-challenge-collaboration-fantasy model can better promote students' engagement in online discussion, as measured by increased interaction with peers, learning experience, and learning performance.

Digital Learning Is an Educational Format towards Sustainable Education

The year 2020, due to the pandemic, was a milestone in the history of digital technology in the education sector, allowing a sustainable education although the world was facing a pandemic crisis without precedents. Therefore, in a few days occur a transformation from traditional classroom teaching to online teaching and consequently forced to use digital learning. Nevertheless, more researches are needed to know how was this experience and if there is the intention to maintain the online format. The main goal of this article is to study how digital learning can be an educational format focused on sustainable education. This paper presents a systematic literature review on digital learning through PRISMA methodology, based on a literature search and field research aimed to analyze the significant predictors related to the digital learning experience on the likelihood of choosing to “keep” the online format in the next academic year. An online survey was conducted with 173 university students. The results obtained showed that the significant predictors were factor 1-”Characteristics of online classes; factor 2-”Support from the School and Professors; factor 3-”Online classes vs. face-to-face classes” and gender. The probability of choosing to keep online classes increases exponentially with the characteristics of online classes, with Support from school and teachers; Online classes vs. Face-to-face classes, and keeping factors 1, 2, and 3 constant the probability if a man chooses the online format compared to a woman is higher. This online format thus acquires central importance in the contemporary sustainability debate. The kind of life, education, and society we will have in the future will depend on the quality, depth, and extent of the learning processes we can create and exercise individually and socially. Education, and educators in particular, who concentrate on the tasks of designing and implementing social teaching and learning models, have a unique responsibility in this process. Although the reduced sample size the present work can provide strategic information for university staff, contributing to designing and implementation a sustainable education.

The Impact of Serious Games in Economic and Business Education: A Case of ERP Business Simulation

Digitalisation nowadays impacts business environments significantly. Therefore, if higher education wants to educate students properly for a successful career path, the business and economics curriculum must be enriched with innovative teaching approaches covering actual topics, such as, for example, the implementation of the ERPsim business simulation, a representative of serious games. The ERPsim business simulation is based on SAP ERP, and is aimed at teaching ERP concepts. It covers different business processes, and allows students to learn using a hands-on approach, simulating real-life scenarios. The presented research focuses on using an ERPsim business simulation as the introduction to the course. The simulation was implemented to ease the introduction of ERP and IT concepts to the business and economic oriented students. Considering the positive effects of serious games and gamification, our research was formed and focused on knowledge acquisition and future student engagement. We researched whether participation in the introductory simulation results in significant knowledge gain and impacts students’ future course engagement. The data were gathered using a self-assessment questionnaire before and after an introductory simulation. The results were highly positive, confirming many positive aspects of business simulation, among others, significant knowledge increase in the domains of business process and ERP transactions, and in the domain of technical knowledge for SAP ERP. The results confirmed that the introductory simulation is appropriate for introducing ERP concepts to newcomers, and, nevertheless, confirmed the positive impact on their intent on future course engagement.