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Kim S, Wilson P, Abraham O. Investigating the Use of Serious Games for Cancer Control Among Children and Adolescents: Scoping Review. JMIR Serious Games 2024; 12:e58724. [PMID: 38985502 PMCID: PMC11269965 DOI: 10.2196/58724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 05/02/2024] [Accepted: 05/29/2024] [Indexed: 07/11/2024] Open
Abstract
BACKGROUND Effective health care services that meet the diverse needs of children and adolescents with cancer are required to alleviate their physical, psychological, and social challenges and improve their quality of life. Previous studies showed that serious games help promote people's health. However, the potential for serious games to be used for successful cancer control for children and adolescents has received less attention. OBJECTIVE This scoping review aimed to map the use of serious games in cancer prevention and cancer care for children and adolescents, and provide future directions for serious games' development and implementation within the context of cancer control for children and adolescents. METHODS This study followed a combination of the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) and the JBI (Joanna Briggs Institute) framework for the conduct of scoping reviews. PubMed, CINAHL Plus Full Text, Scopus, Web of Science Core Collection, and American Psychological Association (APA) PsycINFO databases were used for the search. RESULTS From the initial 2750 search results, 63 papers were included in the review, with 28 quantitative, 14 qualitative, and 21 mixed method studies. Most of the studies were cancer care serious game papers (55/63, 87%) and a small number of studies were cancer prevention serious game papers (8/63, 13%). The majority of the included studies were published between 2019 and 2023 (cancer prevention: 5/8, 63%; cancer care: 35/55, 64%). The majority of the studies were conducted in Europe (cancer prevention: 3/8, 38%; cancer care: 24/55, 44%) and North America (cancer prevention: 4/8, 50%; cancer care: 17/55, 31%). Adolescents were the most represented age group in the studies' participants (cancer prevention: 8/8, 100%; cancer care: 46/55, 84%). All (8/8, 100%) cancer prevention serious game papers included healthy people as participants, and 45 out of 55 (82%) cancer care serious game papers included patients with cancer. The majority of cancer prevention serious game papers addressed game preference as a target outcome (4/8, 50%). The majority of cancer care serious game papers addressed symptom management as a target outcome (28/55, 51%). Of the cancer care studies examining serious games for symptom management, the majority of the studies were conducted to treat psychological (13/55, 24%) and physical symptoms (10/55, 18%). CONCLUSIONS This review shows both the growth of interest in the use of serious games for cancer control among children and adolescents and the potential for bias in the relevant literature. The diverse characteristics of the included papers suggest that serious games can be used in various ways for cancer control among children and adolescents while highlighting the need to develop and implement serious games in underrepresented areas.
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Affiliation(s)
- Sunghak Kim
- National Cancer Survivorship Center, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea
| | - Paije Wilson
- Ebling Library, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Olufunmilola Abraham
- Social and Administrative Sciences Division, School of Pharmacy, University of Wisconsin-Madison, Madison, WI, United States
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Yamaji N, Suzuki D, Suto M, Sasayama K, Ota E. Communication Tools Used in Cancer Communication with Children: A Scoping Review. Cancers (Basel) 2022; 14:cancers14194624. [PMID: 36230548 PMCID: PMC9563078 DOI: 10.3390/cancers14194624] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/19/2022] [Accepted: 09/21/2022] [Indexed: 11/30/2022] Open
Abstract
Simple Summary Despite the potential benefits of effective communication, telling children about unpredictable and life-threatening conditions such as cancer is challenging. This scoping review aimed to map the potential communication tools for children with cancer, their families, and healthcare professionals. We found 25 studies and 21 communication tools. Communication tools might support children to improve their knowledge and psychological outcomes. However, we found a lack of communication tools that were (1) accessible and validated, (2) designed for healthcare professionals, (3) targeted children, families, and healthcare professionals, and (4) were designed to meet the needs of children and families. This review identified areas for further research. Abstract Background: Although communication tools might guide healthcare professionals in communicating with children about cancer, it is unclear what kind of tools are used. This scoping review aimed to map the communication tools used in cancer communication among children with cancer, families, and healthcare professionals. Methods: A comprehensive search using PubMed (including MEDLINE), Embase, CENTRAL, PsycINFO, and CINAHL was conducted on 1 August 2021. We mapped communication tools and their impacts. Results: We included 25 studies (9 experimental studies and 16 feasibility studies) of 29 reports and found 21 communication tools. There was a lack of communication tools that were (1) accessible and validated, (2) designed for healthcare professionals, (3) targeted children, families, and healthcare professionals, and (4) were designed to meet the needs of children and families. Experimental studies showed that the communication tools improved children’s knowledge and psychological outcomes (e.g., health locus of control, quality of life, self-efficacy). Conclusion: We mapped communication tools and identified areas that needed further research, including a lack of tools to guide healthcare professionals and share information with children and families. Further research is needed to develop and evaluate these communication tools. Moreover, it is necessary to investigate how communication tools support children, families, and healthcare professionals.
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Affiliation(s)
- Noyuri Yamaji
- Global Health Nursing, Graduate School of Nursing Science, St. Luke’s International University, 10-1 Akashi-cho, Chuo-ku, Tokyo 104-0044, Japan
- Correspondence:
| | - Daichi Suzuki
- Department of Nursing, Faculty of Health and Medical Sciences, Kanagawa Institute of Technology, 1030 Shimo-ogino, Atsugi 243-0292, Japan
| | - Maiko Suto
- Department of Health Policy, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan
| | - Kiriko Sasayama
- Global Health Nursing, International University of Health and Welfare, 4-3 Kozunomori, Narita, Chiba 286-8686, Japan
| | - Erika Ota
- Global Health Nursing, Graduate School of Nursing Science, St. Luke’s International University, 10-1 Akashi-cho, Chuo-ku, Tokyo 104-0044, Japan
- Tokyo Foundation for Policy Research, Roppongi Grand Tower 34F, 3-2-1 Roppongi, Minato-ku, Tokyo 106-6234, Japan
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Abstract
AbstractSeveral factors can affect the nutritional status of children undergoing cancer therapy. The present review aims to describe children’s food intake during cancer treatments and to explore the contributing determinants. It also assesses the nutritional educational interventions developed for this clientele. Scientific literature from January 1995 to January 2018 was searched through PubMed and MEDLINE using keywords related to childhood cancer and nutritional intake. Quantitative and qualitative studies were reviewed: forty-seven articles were selected: thirty-eight related to food intake and parental practices and nine related to nutritional interventions. Patients’ intakes in energy, macronutrients and micronutrients were compared with those of healthy controls or with requirement standards. Generally, patients ate less energy and proteins than healthy children, but adhered similarly to national guidelines. There is a lack of consensus for standard nutrient requirement in this population and a need for more prospective evaluations. Qualitative studies provide an insight into the perceptions of children, parents and nurses on several determinants influencing eating behaviours, including the type of treatment and their side effects. Parental practices were found to be diverse. In general, savoury and salty foods were preferred to sweet foods. Finally, most interventional studies in childhood cancer have presented their protocol or assessed the feasibility of an intervention. Therefore, because of the variability of study designs and since only a few studies have presented results, their impact on the development of healthful eating habits remains unclear. A better understanding of children’s nutritional intakes and eating behaviours during cancer treatment could guide future nutritional interventions.
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Kim SM, Kim HJ, Hwang HC, Hong JS, Bae S, Min KJ, Han DH. The Effects of a Serious Game on Depressive Symptoms and Anxiety in Breast Cancer Patients with Depression: A Pilot Study Using Functional Magnetic Resonance Imaging. Games Health J 2018; 7:409-417. [PMID: 30383458 DOI: 10.1089/g4h.2017.0183] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: Depression is common in cancer patients. We investigated the effects of playing a serious game in breast cancer patients with mild to moderate depression using functional neuroimaging. Materials and Methods: Thirty-five participants were randomly assigned to the Game group and the Nongame group, and fifteen participants in each group completed the study protocol. Participants in the Game group were asked to play a serious game, "Hit the Cancer" (RAW HAND, Seoul, Korea), for at least 30 minutes/day, 5 days/week, for 3 weeks. Participants in the Nongame group received usual care. At baseline and follow-up, all participants were assessed with the Beck Depression Inventory (BDI), Beck Anxiety Inventory, Stress Response Inventory (SRI), and 3-Tesla resting-state functional magnetic resonance imaging. Changes in functional connectivity (FC) between the brain regions in the default mode network (DMN) and salience network (SN) were analyzed. Results: After the intervention, BDI and SRI scores in the Game group greatly decreased compared with those in the Nongame group. In addition, compared with the Nongame group, the Game group showed decreased postintervention FC between the right posterior cingulate cortex (PCC) of the DMN and right insula of the SN. The improvement in BDI and SRI scores correlated with the decrease in FC between the right PCC and right insula. Conclusion: Selective attention training and repetitive stimulation of the insula by serious game play might cause normalization of the FC between the SN and DMN, thus improving depressive mood.
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Affiliation(s)
- Sun Mi Kim
- Department of Psychiatry, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hee-Jun Kim
- Division of Hemato-oncology, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hyun Chan Hwang
- Department of Psychiatry, Chung-Ang University College of Medicine, Seoul, Korea
| | - Ji Sun Hong
- Department of Psychiatry, Chung-Ang University College of Medicine, Seoul, Korea
| | - Sujin Bae
- Department of Psychiatry, Chung-Ang University College of Medicine, Seoul, Korea
| | - Kyoung Joon Min
- Department of Psychiatry, Chung-Ang University College of Medicine, Seoul, Korea
| | - Doug Hyun Han
- Department of Psychiatry, Chung-Ang University College of Medicine, Seoul, Korea
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Bruggers CS, Baranowski S, Beseris M, Leonard R, Long D, Schulte E, Shorter A, Stigner R, Mason CC, Bedrov A, Pascual I, Bulaj G. A Prototype Exercise-Empowerment Mobile Video Game for Children With Cancer, and Its Usability Assessment: Developing Digital Empowerment Interventions for Pediatric Diseases. Front Pediatr 2018; 6:69. [PMID: 29686977 PMCID: PMC5900044 DOI: 10.3389/fped.2018.00069] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 03/08/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Medical advances continue to improve morbidity and mortality of serious pediatric diseases, including cancer, driving research addressing diminished physical and psychological quality of life in children with these chronic conditions. Empowerment enhances resilience and positively influences health, disease, and therapy understanding. We describe the development and usability assessment of a prototype Empower Stars! mobile video game grounded in behavioral and exercise theories with the purpose of coupling physical exercise with empowerment over disease in children with cancer. METHODS Academic faculty, health-care providers, and community video game developers collaborated in this project. The iPadAir was selected as a delivery platform for its accelerometer and gyroscope features facilitating exercise design. Unity multiplatform technology provided animation and audiovisual features for immediate player feedback. Javascript, C#, Photoshop, Flash, and SketchUp were used for coding, creating graphical assets, Sprite sheets, and printing files, respectively. 3D-printed handles and case backing were used to adapt the iPad for physical exercise. Game usability, engagement, and enjoyment were assessed via a multilevel study of children undergoing cancer chemotherapy, their parents, and pediatric cancer health-care providers. Feedback crucial for ongoing game development was analyzed. RESULTS A prototype Empower Stars! mobile video game was developed for children 7-14 years old with cancer. Active, sedentary, educational, and empowerment-centered elements intermix for 20 min of exercise within a 30 min "one-day treatment" gameplay session involving superheroes, space exploration, metaphorical cancer challenges, life restoration on a barren planet, and innumerable star rewards. No player "dies." Usability assessment data analyses showed widespread enthusiasm for integrating exercise with empowerment over cancer and the game itself. Favorite elements included collecting star rewards and planet terraforming. Traveling in space and the Healthy Food Choice game were least liked. The need for improved gameplay instructions was expressed by all groups. The usability study provided essential feedback for converting the prototype into alpha version of Empower Stars! CONCLUSION Adapting exercise empowerment-promoting video game technology to mobile platforms facilitates usability and widespread dissemination for children with cancer. We discuss broader therapeutic applicability in diverse chronic pediatric diseases, including obesity, asthma, cystic fibrosis, diabetes, and juvenile idiopathic arthritis.
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Affiliation(s)
- Carol S Bruggers
- Division of Hematology-Oncology, Department of Pediatrics, University of Utah, Salt Lake City, UT, United States.,Primary Children's Hospital, Salt Lake City, UT, United States
| | | | | | | | - Derek Long
- Spy Hop Youth Media, Salt Lake City, UT, United States
| | | | | | - Rowan Stigner
- Spy Hop Youth Media, Salt Lake City, UT, United States
| | - Clinton C Mason
- Division of Hematology-Oncology, Department of Pediatrics, University of Utah, Salt Lake City, UT, United States
| | - Alisa Bedrov
- Division of Hematology-Oncology, Department of Pediatrics, University of Utah, Salt Lake City, UT, United States.,Department of Medicinal Chemistry, College of Pharmacy, University of Utah, Salt Lake City, UT, United States
| | - Ian Pascual
- Division of Hematology-Oncology, Department of Pediatrics, University of Utah, Salt Lake City, UT, United States.,Department of Medicinal Chemistry, College of Pharmacy, University of Utah, Salt Lake City, UT, United States.,Juan Diego Catholic High School, Draper, UT, United States
| | - Grzegorz Bulaj
- Department of Medicinal Chemistry, College of Pharmacy, University of Utah, Salt Lake City, UT, United States
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Lau PW, Lau EY, Wang JJ, Choi CR, Kim CG. A Pilot Study of the Attractive Features of Active Videogames Among Chinese Primary School Children. Games Health J 2017; 6:87-96. [DOI: 10.1089/g4h.2016.0021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
- Patrick W.C. Lau
- Department of Physical Education, Faculty of Social Sciences, Hong Kong Baptist University, Hong Kong
| | - Erica Y. Lau
- School of Kinesiology, University of British Columbia, Vancouver, Canada
| | - Jing Jing Wang
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
| | - Cheong-rak Choi
- Division of Sport Science, College of Science and Technology, Konkuk University, Seoul, South Korea
| | - Chang Gyun Kim
- Division of Sports Science, College of Arts and Design, Gachon University, Seongnam, South Korea
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Calinescu AM, McLin V, Spahni S, Boggini T, Randriambelonoro M, Jaquier-Grant R, Steiner M, Geissbuhler A, Wildhaber BE. [KidsETransplant: a serious game for liver transplanted children]. Med Sci (Paris) 2017; 32:1120-1126. [PMID: 28044976 DOI: 10.1051/medsci/20163212016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Serious games are increasingly used in pediatric care, especially to educate young patients with chronic diseases, to improve their understanding of the disease and develop independence in disease management, as it can ultimately improve clinical results. This is also true for liver transplanted children and adolescents, who are not only challenged by their therapeutic burden, but who need to face transition to adult care, often without remembering their transplantation, which was performed, most of the time, very early in their life. KidsETransplant aims to improve long term outcomes of liver transplanted patients, using the principle of a serious game in 3D.
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Affiliation(s)
- Ana-Maria Calinescu
- Centre universitaire romand de chirurgie pédiatrique, Service de chirurgie pédiatrique, Hôpitaux Universitaires de Genève, Rue Willy Donzé 6, 1211 Genève, Suisse
| | - Valérie McLin
- Unité de gastroentérologie et hépatologie pédiatrique, Hôpitaux Universitaires de Genève, Rue Willy Donzé 6, 1211 Genève, Suisse
| | - Stéphane Spahni
- Service de cyber-santé et télémédecine, Hôpitaux Universitaires de Genève, Rue Willy Donzé 6, 1211 Genève, Suisse
| | - Thomas Boggini
- Service de cyber-santé et télémédecine, Hôpitaux Universitaires de Genève, Rue Willy Donzé 6, 1211 Genève, Suisse
| | - Mirana Randriambelonoro
- Service de cyber-santé et télémédecine, Hôpitaux Universitaires de Genève, Rue Willy Donzé 6, 1211 Genève, Suisse
| | - Roxane Jaquier-Grant
- Centre universitaire romand de chirurgie pédiatrique, Service de chirurgie pédiatrique, Hôpitaux Universitaires de Genève, Rue Willy Donzé 6, 1211 Genève, Suisse
| | - Michèle Steiner
- Unité de gastroentérologie et hépatologie pédiatrique, Hôpitaux Universitaires de Genève, Rue Willy Donzé 6, 1211 Genève, Suisse
| | - Antoine Geissbuhler
- Service de cyber-santé et télémédecine, Hôpitaux Universitaires de Genève, Rue Willy Donzé 6, 1211 Genève, Suisse
| | - Barbara E Wildhaber
- Centre universitaire romand de chirurgie pédiatrique, Service de chirurgie pédiatrique, Hôpitaux Universitaires de Genève, Rue Willy Donzé 6, 1211 Genève, Suisse
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Francis DB, Comello MLG, Marshall LH. How Does Gameplaying Support Values and Psychological Well-Being Among Cancer Survivors? Games Health J 2016; 5:128-34. [PMID: 26959395 DOI: 10.1089/g4h.2015.0044] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE This qualitative study examined the extent to which playing recreational computer games and videogames is perceived by cancer survivors as supporting personal values. Values serve as behavioral guides and may thus impact health outcomes; therefore activities that have the potential to support values deserve further attention so their role in promoting health may be better understood. MATERIALS AND METHODS We asked a sample of survivors who play recreational games (n = 73) open-ended questions about the types of recreational games they play, about something they really value in life, and the extent to which playing games supports the value. Data analysis used a grounded theory approach, supported by computer-assisted qualitative analysis software. RESULTS Three major themes emerged linking gameplaying to survivors' values: the need to create and maintain social connections, the desire to help others, and the need to experience alternate realities (including escape and exploration). CONCLUSIONS The present study offers a unique perspective by focusing on the intersection of values and gameplay among survivors. The findings suggest that playing recreational computer games and videogames may be congruent with survivors' personal values and may have potential to influence positive health outcomes among survivors. The findings have implications for developing effective values-based interventions for cancer survivors.
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Affiliation(s)
- Diane B Francis
- School of Media and Journalism, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina
| | - Maria Leonora G Comello
- School of Media and Journalism, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina
| | - Laura Heisner Marshall
- School of Media and Journalism, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina
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Bulaj G, Ahern MM, Kuhn A, Judkins ZS, Bowen RC, Chen Y. Incorporating Natural Products, Pharmaceutical Drugs, Self-Care and Digital/Mobile Health Technologies into Molecular-Behavioral Combination Therapies for Chronic Diseases. CURRENT CLINICAL PHARMACOLOGY 2016; 11:128-45. [PMID: 27262323 PMCID: PMC5011401 DOI: 10.2174/1574884711666160603012237] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 05/30/2016] [Accepted: 05/31/2016] [Indexed: 02/08/2023]
Abstract
Merging pharmaceutical and digital (mobile health, mHealth) ingredients to create new therapies for chronic diseases offers unique opportunities for natural products such as omega-3 polyunsaturated fatty acids (n-3 PUFA), curcumin, resveratrol, theanine, or α-lipoic acid. These compounds, when combined with pharmaceutical drugs, show improved efficacy and safety in preclinical and clinical studies of epilepsy, neuropathic pain, osteoarthritis, depression, schizophrenia, diabetes and cancer. Their additional clinical benefits include reducing levels of TNFα and other inflammatory cytokines. We describe how pleiotropic natural products can be developed as bioactive incentives within the network pharmacology together with pharmaceutical drugs and self-care interventions. Since approximately 50% of chronically-ill patients do not take pharmaceutical drugs as prescribed, psychobehavioral incentives may appeal to patients at risk for medication non-adherence. For epilepsy, the incentive-based network therapy comprises anticonvulsant drugs, antiseizure natural products (n-3 PUFA, curcumin or/and resveratrol) coupled with disease-specific behavioral interventions delivered by mobile medical apps. The add-on combination of antiseizure natural products and mHealth supports patient empowerment and intrinsic motivation by having a choice in self-care behaviors. The incentivized therapies offer opportunities: (1) to improve clinical efficacy and safety of existing drugs, (2) to catalyze patient-centered, disease self-management and behavior-changing habits, also improving health-related quality-of-life after reaching remission, and (3) merging copyrighted mHealth software with natural products, thus establishing an intellectual property protection of medical treatments comprising the natural products existing in public domain and currently promoted as dietary supplements. Taken together, clinical research on synergies between existing drugs and pleiotropic natural products, and their integration with self-care, music and mHealth, expands precision/personalized medicine strategies for chronic diseases via pharmacological-behavioral combination therapies.
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Affiliation(s)
- Grzegorz Bulaj
- Department of Medicinal Chemistry, College of Pharmacy, Skaggs Pharmacy Institute, University of Utah, 30 South 2000 East, Salt Lake City, Utah 84112, USA.
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Baranowski T, Buday R, Thompson D, Lyons EJ, Lu AS, Baranowski J. Developing Games for Health Behavior Change: Getting Started. Games Health J 2013; 2:183-190. [PMID: 24443708 DOI: 10.1089/g4h.2013.0048] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Many investigators are considering developing videogames for health (video-G4Hs) but have questions about how to get started. This report provides guidance for investigators considering a G4H as a behavioral intervention procedure from a team of experienced G4H developers. Thirteen commonly asked questions are answered, including defining a G4H, considerations in developing a team, considerations in G4H design, and anticipating unintended consequences.
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Affiliation(s)
- Tom Baranowski
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | | | - Debbe Thompson
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Elizabeth J Lyons
- Institute for Translational Sciences, The University of Texas Medical Branch, Galveston, Texas
| | - Amy Shirong Lu
- Department of Communication Studies, School of Communication, Northwestern University, Evanston, Illinois
| | - Janice Baranowski
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
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