1
|
Radhakrishnan K, Julien C, O'Hair M, Tunis R, Lee G, Rangel A, Custer J, Baranowski T, Rathouz PJ, Kim MT. Sensor-Controlled Digital Game for Heart Failure Self-management: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e45801. [PMID: 37163342 PMCID: PMC10209796 DOI: 10.2196/45801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/14/2023] [Accepted: 03/21/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Heart failure (HF) is the leading cause of hospitalization among older adults in the United States. There are substantial racial and geographic disparities in HF outcomes, with patients living in southern US states having a mortality rate 69% higher than the national average. Self-management behaviors, particularly daily weight monitoring and physical activity, are extremely important in improving HF outcomes; however, patients typically have particularly low adherence to these behaviors. With the rise of digital technologies to improve health outcomes and motivate health behaviors, sensor-controlled digital games (SCDGs) have become a promising approach. SCDGs, which leverage sensor-connected technologies, offer the benefits of being portable and scalable and allowing for continuous observation and motivation of health behaviors in their real-world contexts. They are also becoming increasingly popular among older adults and offer an immersive and accessible way to measure self-management behaviors and improve adherence. No SCDGs have been designed for older adults or evaluated to test their outcomes. OBJECTIVE This randomized clinical trial aims to assess the efficacy of a SCDG in integrating the behavioral data of participants with HF from weight scale and activity tracker sensors to activate game progress, rewards, and feedback and, ultimately, to improve adherence to important self-management behaviors. METHODS A total of 200 participants with HF, aged ≥45 years, will be recruited and randomized into 2 groups: the SCDG playing group (intervention group) and sensor-only group (control group). Both groups will receive a weight scale, physical activity tracker, and accompanying app, whereas only the intervention group will play the SCDG. This design, thereby, assesses the contributions of the game. All participants will complete a baseline survey as well as posttests at 6 and 12 weeks to assess the immediate effect of the intervention. They will also complete a third posttest at 24 weeks to assess the maintenance of behavioral changes. Efficacy and benefits will be assessed by measuring improvements in HF-related proximal outcomes (self-management behaviors of daily weight monitoring and physical activity) and distal outcomes (HF hospitalization, quality of life, and functional status) between baseline and weeks 6, 12, and 24. The primary outcome measured will be days with weight monitoring, for which this design provides at least 80% power to detect differences between the 2 groups. RESULTS Recruitment began in the fall of 2022, and the first patient was enrolled in the study on November 7, 2022. Recruitment of the last participant is expected in quarter 1 of 2025. Publication of complete results and data from this study is expected in 2026. CONCLUSIONS This project will generate insight and guidance for scalable and easy-to-use digital gaming solutions to motivate persistent adherence to HF self-management behaviors and improve health outcomes among individuals with HF. TRIAL REGISTRATION ClinicalTrials.gov NCT05056129; https://clinicaltrials.gov/ct2/show/NCT05056129. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/45801.
Collapse
Affiliation(s)
| | - Christine Julien
- Department of Electrical and Computer Engineering, University of Texas at Austin, Austin, TX, United States
| | | | - Rachel Tunis
- School of Information, University of Texas at Austin, Austin, TX, United States
| | - Grace Lee
- Department of Electrical and Computer Engineering, University of Texas at Austin, Austin, TX, United States
| | - Angelica Rangel
- School of Nursing, The University of Texas at Austin, Austin, TX, United States
| | - James Custer
- Department of Population Health, Dell Medical School, The University of Texas at Austin, Austin, TX, United States
| | - Tom Baranowski
- Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
| | - Paul J Rathouz
- Department of Population Health, Dell Medical School, The University of Texas at Austin, Austin, TX, United States
| | - Miyong T Kim
- School of Nursing, The University of Texas at Austin, Austin, TX, United States
| |
Collapse
|
2
|
Radhakrishnan K, Julien C, Baranowski T, O'Hair M, Lee G, Sagna De Main A, Allen C, Viswanathan B, Thomaz E, Kim M. Feasibility of a Sensor-Controlled Digital Game for Heart Failure Self-management: Randomized Controlled Trial. JMIR Serious Games 2021; 9:e29044. [PMID: 34747701 PMCID: PMC8663490 DOI: 10.2196/29044] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/03/2021] [Accepted: 06/28/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Poor self-management of heart failure (HF) contributes to devastating health consequences. Our innovative sensor-controlled digital game (SCDG) integrates data from sensors to trigger game rewards, progress, and feedback based on the real-time behaviors of individuals with HF. OBJECTIVE The aim of this study is to compare daily weight monitoring and physical activity behavior adherence by older adults using an SCDG intervention versus a sensors-only intervention in a feasibility randomized controlled trial. METHODS English-speaking adults with HF aged 55 years or older who owned a smartphone and could walk unassisted were recruited from Texas and Oklahoma from November 2019 to August 2020. Both groups were given activity trackers and smart weighing scales to track behaviors for 12 weeks. The feasibility outcomes of recruitment, retention, intervention engagement, and satisfaction were assessed. In addition to daily weight monitoring and physical activity adherence, the participants' knowledge, functional status, quality of life, self-reported HF behaviors, motivation to engage in behaviors, and HF-related hospitalization were also compared between the groups at baseline and at 6, 12, and 24 weeks. RESULTS A total of 38 participants with HF-intervention group (IG; 19/38, 50%) and control group (CG; 19/38, 50%)-were enrolled in the study. Of the 38 participants, 18 (47%) were women, 18 (47%) were aged 65 years or older, 21 (55%) had been hospitalized with HF in the past 6 months, and 29 (76%) were White. Furthermore, of these 38 participants, 31 (82%)-IG (15/19, 79%) and CG (16/19, 84%)-had both weight monitoring and physical activity data at the end of 12 weeks, and 27 (71%)-IG (14/19, 74%) and CG (13/19, 68%)-participated in follow-up assessments at 24 weeks. For the IG participants who installed the SCDG app (15/19, 79%), the number of days each player opened the game app was strongly associated with the number of days the player engaged in weight monitoring (r=0.72; P=.04) and the number of days with physical activity step data (r=0.9; P<.001). The IG participants who completed the satisfaction survey (13/19, 68%) reported that the SCDG was easy to use. Trends of improvement in daily weight monitoring and physical activity in the IG, as well as within-group improvements in HF functional status, quality of life, knowledge, self-efficacy, and HF hospitalization in both groups, were observed in this feasibility trial. CONCLUSIONS Playing an SCDG on smartphones was feasible and acceptable for older adults with HF for motivating daily weight monitoring and physical activity. A larger efficacy trial of the SCDG intervention will be needed to validate trends of improvement in daily weight monitoring and physical activity behaviors. TRIAL REGISTRATION ClinicalTrials.gov NCT03947983; https://clinicaltrials.gov/ct2/show/NCT03947983.
Collapse
Affiliation(s)
| | - Christine Julien
- Department of Electrical and Computer Engineering, Cockrell School of Engineering, The University of Texas Austin, Austin, TX, United States
| | | | | | - Grace Lee
- Department of Electrical and Computer Engineering, Cockrell School of Engineering, The University of Texas Austin, Austin, TX, United States
| | - Atami Sagna De Main
- School of Nursing, The University of Texas Austin, Austin, TX, United States
| | - Catherine Allen
- School of Nursing, The University of Texas Austin, Austin, TX, United States
| | - Bindu Viswanathan
- Department of Statistics and Data Sciences, The University of Texas Austin, Austin, TX, United States
| | - Edison Thomaz
- Department of Electrical and Computer Engineering, Cockrell School of Engineering, The University of Texas Austin, Austin, TX, United States
| | - Miyong Kim
- School of Nursing, The University of Texas Austin, Austin, TX, United States
| |
Collapse
|
3
|
Alon D, Sousa CV, Lu AS. What Type of Body Shape Moves Children? An Experimental Exploration of the Impact of Narrative Cartoon Character Body Shape on Children's Narrative Engagement, Wishful Identification, and Exercise Motivation. Front Psychol 2021; 12:653626. [PMID: 34322057 PMCID: PMC8312721 DOI: 10.3389/fpsyg.2021.653626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 05/26/2021] [Indexed: 11/30/2022] Open
Abstract
Background The incorporation of narratives helps to enhance children’s engagement in active video games (AVGs), thus increasing moderate-to-vigorous physical activity (MVPA). Specific narrative elements, such as the visual representation of the characters’ body shape, have been rarely manipulated to explore their role in modulating children’s narrative engagement (NE) and exercise motivation. Objective To investigate the effects of character body shape manipulation (overweight/obese, average, or athletic slim) on children’s narrative immersion (NI), NE, wishful identification (WI), as well as their mediating effect on AVG and PA motivation. Methods Children ages 8–12 years old (N = 87) were randomly assigned to watch a 15-min animated video (designed for an existing AVG) in which the main characters had an overweight/obese, or average∗, or athletic slim body shape (all other elements were identical). Children’s NI, NE, WI, and AVG and physical activity (PA) motivation were then assessed. Results Controlling for social desirability, the analysis indicated that participants with a BMI of greater than the 75th percentile had a significantly higher NI, NE, WI, and PA motivation when video characters were set to the overweight/obese condition, than they did for video characters set to the average or athletic slim conditions. On the other hand, children of equal or less than the 75th percentile exposed to the average character body condition had a greater NE, WI, and PA motivation than overweight/obese or athletic slim conditions. A mediation analysis with structural equation modeling indicated that NE mediated the effect between character body shape and AVG and PA motivation. Conclusion Narrative cartoon characters that mirror the target participant’s body shape can increase NE, which in turn mediates AVG and PA motivation. Content producers should identify optimal strategies in character body shape design to encourage children of different weight status to participate in PA with engaging stories to maximize health narratives’ persuasive potentials. ∗The term average in this sense is not in reference to the national average body weight, but rather an average of the body weights represented in conditions A and C.
Collapse
Affiliation(s)
- Dar Alon
- Health Technology Lab, College of Arts, Media and Design, Bouvé College of Health Sciences, Northeastern University, Boston, MA, United States
| | - Caio Victor Sousa
- Health Technology Lab, College of Arts, Media and Design, Bouvé College of Health Sciences, Northeastern University, Boston, MA, United States
| | - Amy Shirong Lu
- Health Technology Lab, College of Arts, Media and Design, Bouvé College of Health Sciences, Northeastern University, Boston, MA, United States
| |
Collapse
|
4
|
Alon D, Sousa CV, Baranowski T, Barreira TV, Cabrera-Perez R, Chiu K, Fernandez A, Fleischman A, Huang S, Hwang J, Green MC, Lee IM, Lee K, Lessard S, Levitsky LL, Misawa A, Noubary F, Samuels R, Sun KJ, Thompson D, Lu AS. The impact of narratives and active video games on long-term moderate-to-vigorous physical activity: A randomized controlled trial protocol. Contemp Clin Trials 2020; 96:106087. [PMID: 32682995 PMCID: PMC7494553 DOI: 10.1016/j.cct.2020.106087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 07/10/2020] [Accepted: 07/13/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Although physical activity (PA) has been shown in helping prevent and treat obesity, current PA interventions are still not effective in ameliorating the obesity epidemic. Additional forms of PA need to be investigated to improve PA engagement and outcomes. We hypothesize that pairing a narrative (i.e., story) with an active video game (AVG), a less traditional form of PA, will increase participant engagement in PA. This paper presents the rationale, implementation, and pilot results of a study assessing the effect of narrative's impact on PA and a series of other health outcomes. OBJECTIVE This paper presents the rationale, implementation, and pilot results of a study assessing the effect of narrative's impact on PA and a series of other health outcomes. METHODS/DESIGN The Active Video Game Study is a six-month randomized controlled single-blind trial projected to include 210 participants. The intervention strategy will pair a narrative to an active video game (AVG). Participants will be randomized into 3 groups: condition A [Narrative + AVG], condition B [AVG Only], and condition C [Control]. Participants will undergo three in-person data collection visits over the course of six months. Inclusion criteria are that children are between the ages of 8-12 and have a BMI ≥ 85%. The primary outcome is change in moderate to vigorous physical activity (MVPA). Secondary outcome measures include change in BMI percentile, fasting insulin and glucose, lipid panel, C-reactive protein, and cognitive function. A pilot trial of n = 6 was conducted to help develop procedures and address problems that could arise in the main trial. DISCUSSION Successful completion of this study will provide the empirical basis for novel intervention and design strategies to enhance the impact of AVGs on long-term MVPA.
Collapse
Affiliation(s)
- Dar Alon
- Health Technology Lab, College of Arts, Media, and Design, Bouvé College of Health Sciences, Northeastern University, 360 Huntington Ave, Boston, MA 02115, United States
| | - Caio Victor Sousa
- Health Technology Lab, College of Arts, Media, and Design, Bouvé College of Health Sciences, Northeastern University, 360 Huntington Ave, Boston, MA 02115, United States
| | - Tom Baranowski
- Distinguished Emeritus Professor, Baylor College of Medicine, 1100 Bates St, Houston, TX 77030, United States
| | - Tiago V Barreira
- Exercise Science Department, Syracuse University, 820 Comstock Ave, Syracuse, NY 13244, United States
| | - Romina Cabrera-Perez
- Health Technology Lab, College of Arts, Media, and Design, Bouvé College of Health Sciences, Northeastern University, 360 Huntington Ave, Boston, MA 02115, United States
| | - Kelly Chiu
- Harvard Medical School, Primary Care Martha Eliot, 75 Bickford St, Jamaica Plain, MA 02478, United States
| | - Austin Fernandez
- Health Technology Lab, College of Arts, Media, and Design, Bouvé College of Health Sciences, Northeastern University, 360 Huntington Ave, Boston, MA 02115, United States
| | - Amy Fleischman
- Harvard Medical School, Optimal Wellness for Life Clinic, Boston Children's Hospital, Boston, MA 02115, United States
| | - Shirley Huang
- Division of General Pediatrics and Adolescent Medicine, Floating Hospital for Children at Tufts Medical Center, Boston, MA 02111, United States
| | - Jungyun Hwang
- Department of Medicine, Stanford University Medical Center, Palo Alto, CA 94304, United States
| | - Melanie C Green
- Department of Communication, University at Buffalo, 359 Baldy Hall, Buffalo, NY 14260, United States
| | - I-Min Lee
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02215, United States
| | - Kelly Lee
- Health Technology Lab, College of Arts, Media, and Design, Bouvé College of Health Sciences, Northeastern University, 360 Huntington Ave, Boston, MA 02115, United States
| | - Sarah Lessard
- Research Division, Joslin Diabetes Center, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02215, United States
| | - Lynne L Levitsky
- Pediatric Endocrinology, Massachusetts General Hospital, Pediatrics, Harvard Medical School, 175 Cambridge St 5(th) Floor, Boston, MA 02114, United States
| | - Aika Misawa
- Health Technology Lab, College of Arts, Media, and Design, Bouvé College of Health Sciences, Northeastern University, 360 Huntington Ave, Boston, MA 02115, United States
| | - Farzad Noubary
- Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, 360 Huntington Ave, Boston, MA 02115, United States
| | - Ronald Samuels
- Children's Hospital Primary Care Center, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, United States
| | - Kyung Jin Sun
- Health Technology Lab, College of Arts, Media, and Design, Bouvé College of Health Sciences, Northeastern University, 360 Huntington Ave, Boston, MA 02115, United States
| | - Debbe Thompson
- USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, 1100 Bates Avenue, Houston, TX 77030, United States
| | - Amy S Lu
- Health Technology Lab, College of Arts, Media, and Design, Bouvé College of Health Sciences, Northeastern University, 360 Huntington Ave, Boston, MA 02115, United States.
| |
Collapse
|
5
|
Ozer EM, Rowe J, Tebb KP, Berna M, Penilla C, Giovanelli A, Jasik C, Lester JC. Fostering Engagement in Health Behavior Change: Iterative Development of an Interactive Narrative Environment to Enhance Adolescent Preventive Health Services. J Adolesc Health 2020; 67:S34-S44. [PMID: 32718513 PMCID: PMC9575382 DOI: 10.1016/j.jadohealth.2020.04.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 02/24/2020] [Accepted: 04/22/2020] [Indexed: 12/28/2022]
Abstract
PURPOSE Accidents and unintentional injuries account for the greatest number of adolescent deaths, often involving use of alcohol and other substances. This article describes the iterative design and development of Interactive Narrative System for Patient-Individualized Reflective Exploration (INSPIRE), a narrative-centered behavior change environment for adolescents focused on reducing alcohol use. INSPIRE is designed to serve as an extension to clinical preventive care, engaging adolescents in a theoretically grounded intervention for health behavior change by leveraging 3D game engine and interactive narrative technologies. METHODS Adolescents were engaged in all aspects of the iterative, multiyear development process of INSPIRE through over 20 focus groups and iterative pilot testing involving more than 145 adolescents. Qualitative findings from focus groups are reported, as well as quantitative findings from small-scale pilot sessions investigating adolescent engagement with a prototype version of INSPIRE using a combination of questionnaire and interaction trace log data. RESULTS Adolescents reported that they found INSPIRE to be engaging, believable, and relevant to their lives. The majority of participants indicated that the narrative's protagonist character was like them (84%) and that the narrative featured virtual characters that they could relate to (79%). In the interactive narrative, the goals most frequently chosen by adolescents were "stay in control" (60%) and "do not get in trouble" (55%). CONCLUSIONS With a strong theoretical framework (social-cognitive behavior change theory) and technology advances (narrative-centered learning environments), the field is well positioned to design health behavior change systems that can realize significant impacts on behavior change for adolescent preventive health.
Collapse
Affiliation(s)
- Elizabeth M Ozer
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, San Francisco, California; Office of Diversity & Outreach, University of California, San Francisco, San Francisco, California.
| | - Jonathan Rowe
- Department of Computer Science, College of Engineering, North Carolina State University, Raleigh, North Carolina
| | - Kathleen P Tebb
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, San Francisco, California
| | - Mark Berna
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, San Francisco, California
| | - Carlos Penilla
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, San Francisco, California
| | - Alison Giovanelli
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, San Francisco, California
| | - Carolyn Jasik
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco, San Francisco, California
| | - James C Lester
- Department of Computer Science, College of Engineering, North Carolina State University, Raleigh, North Carolina
| |
Collapse
|
6
|
Montagni I, Mabchour I, Tzourio C. Digital Gamification to Enhance Vaccine Knowledge and Uptake: Scoping Review. JMIR Serious Games 2020; 8:e16983. [PMID: 32348271 PMCID: PMC7265110 DOI: 10.2196/16983] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 03/13/2020] [Accepted: 03/20/2020] [Indexed: 01/18/2023] Open
Abstract
Background Vaccine hesitancy is a growing threat to population health, and effective interventions are needed to reduce its frequency. Digital gamification is a promising new approach to tackle this public health issue. Objective The purpose of this scoping review was to assess the amount and quality of outcomes in studies evaluating gamified digital tools created to increase vaccine knowledge and uptake. Methods We searched for peer-reviewed articles published between July 2009 and August 2019 in PubMed, Google Scholar, Journal of Medical Internet Research, PsycINFO, PsycARTICLES, Psychology and Behavioral Sciences Collection, and SocINDEX. Studies were coded by author, year of publication, country, journal, research design, sample size and characteristics, type of vaccine, theory used, game content, game modality, gamification element(s), data analysis, type of outcomes, and mean quality score. Outcomes were synthesized through the textual narrative synthesis method. Results A total of 7 articles met the inclusion criteria and were critically reviewed. Game modalities and gamification elements were diverse, but role play and a reward system were present in all studies. These articles included a mixture of randomized controlled trials, quasi-experimental studies, and studies comprising quantitative and qualitative measures. The majority of the studies were theory-driven. All the identified gamified digital tools were highly appreciated for their usability and were effective in increasing awareness of vaccine benefits and motivation for vaccine uptake. Conclusions Despite the relative paucity of studies on this topic, this scoping review suggests that digital gamification has strong potential for increasing vaccination knowledge and, eventually, vaccination coverage.
Collapse
Affiliation(s)
- Ilaria Montagni
- Bordeaux Population Health U1219, Inserm-University of Bordeaux, Bordeaux, France.,Institute of Public Health, Epidemiology and Development (ISPED), University of Bordeaux, Bordeaux, France
| | - Inass Mabchour
- Faculty of Medicine Hyacinthe Bastaraud, University of Antilles-Guyane, Pointe-à-Pitre, Guadeloupe
| | - Christophe Tzourio
- Bordeaux Population Health U1219, Inserm-University of Bordeaux, Bordeaux, France
| |
Collapse
|
7
|
Green MC, Jenkins KM. Need for Cognition, Transportability, and Engagement with Interactive Narratives. Games Health J 2020; 9:182-186. [PMID: 31934790 DOI: 10.1089/g4h.2019.0095] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective: Games for heath can take the form of interactive narratives, or stories in which readers have the option to make decisions about the direction of the plot. Individual differences may affect the extent to which individuals become engaged in such narratives. Materials and Methods: In two studies, we randomly assigned participants to read either a traditional linear narrative or an interactive version of the same narrative. We examined the influence of need for cognition (NFC) and transportability (the extent to which individuals tend to become immersed in narratives) on transportation, character identification, and perceived realism. Results: Transportability led to higher perceptions of realism in the interactive narrative in Study 1, but this effect was not replicated in Study 2. In Study 1, higher NFC led to greater identification in the interactive narrative; in Study 2, higher NFC led to greater transportation into the interactive narrative. Conclusion: Greater willingness to exert mental effort may lead to greater immersion in interactive narratives.
Collapse
Affiliation(s)
- Melanie C Green
- Department of Communication, University at Buffalo, Buffalo, New York
| | - Keenan M Jenkins
- Department of Psychology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| |
Collapse
|
8
|
Baranowski T, Thompson D. Descriptive Normative Nutrition Messages to Maximize Effect in a Videogame: Narrative Review. Games Health J 2020; 9:237-254. [PMID: 31905035 DOI: 10.1089/g4h.2019.0106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Messages containing descriptive norms have been manipulated and tested for effects on dietary intake in a number of studies. The effects have been mostly small or nonexistent. This narrative review analyzed the structural elements of the nutrition messages most likely related to effectiveness. Elements examined included the following: source, similarity of source to the participant, reference group, identification with or evaluative significance of the reference group, delivery, salience, background, tailoring, gain-loss framing, and whether an assessment of the group norm was conducted before designing the descriptive norm message. Most studies incorporated few of the reviewed structural elements, and message manipulations appeared weak. Controlled, systematic studies are needed to examine the effect of the structural elements, singly and in combination, on behavior and its mediators. Videogames are designed to be delivered in the same way to players; therefore, they offer a controlled environment for extensively and systematically manipulating structural elements of messages and examining the resulting behavioral effects. How this might be accomplished was described. Experimental research was identified as being necessary to delineate the individual and combined element effects, thereby contributing to the body of literature on videogame design and effectiveness.
Collapse
Affiliation(s)
- Tom Baranowski
- Department of Pediatrics, Baylor College of Medicine, USDA/ARS Children's Nutrition Research Center, Houston, Texas
| | - Debbe Thompson
- Department of Pediatrics, Baylor College of Medicine, USDA/ARS Children's Nutrition Research Center, Houston, Texas
| |
Collapse
|
9
|
Zhou C, Occa A, Kim S, Morgan S. A Meta-analysis of Narrative Game-based Interventions for Promoting Healthy Behaviors. JOURNAL OF HEALTH COMMUNICATION 2019; 25:54-65. [PMID: 31829829 DOI: 10.1080/10810730.2019.1701586] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Health interventions that use serious games have become increasingly popular. However, many of these games have been designed with few immersive game features which would improve users' engagement with the persuasive messages. To address this issue, researchers have incorporated narrative elements in games to facilitate message processing and enhance behavioral change. There have been theoretical debates about whether narratives benefit these interventions; empirical evidences for their effects are slightly mixed. This meta-analysis provides a deeper understanding of the overall impact of narrative game-based interventions on health-related behaviors and their psychological determinants. Combining the results from 22 studies, this meta-analysis found that narrative game-based interventions were effective in changing behaviors, knowledge, self-efficacy, and enjoyment. These effects were moderated by factors such as the genre of the game, the genre of the story, group play, and participant age. Implications of the findings and suggestions for future design of narrative game-based interventions were discussed.
Collapse
Affiliation(s)
- Chun Zhou
- Department of Communication, College of Communication, Architecture + The Arts, Florida International University, Miami, Florida, USA
| | - Aurora Occa
- Department of Communication, College of Communication and Information, University of Kentucky, Lexington, Kentucky, USA
| | - Soyoon Kim
- Department of Communication Studies, School of Communication, University of Miami, Coral Gables, Florida, USA
| | - Susan Morgan
- Department of Communication Studies, School of Communication, University of Miami, Coral Gables, Florida, USA
| |
Collapse
|
10
|
Lu AS, Green MC, Thompson D. Using Narrative Game Design to Increase Children's Physical Activity: Exploratory Thematic Analysis. JMIR Serious Games 2019; 7:e16031. [PMID: 31750833 PMCID: PMC6895869 DOI: 10.2196/16031] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 09/23/2019] [Accepted: 10/17/2019] [Indexed: 01/23/2023] Open
Abstract
Background Physical activity is crucial for child obesity prevention and intervention. Narratives embedded in active games can increase children’s physical activity. Objective Little is known about the narrative characteristics that would motivate children to exercise. We attempted to fill the gaps in understanding regarding narrative design for active video games. Methods In this exploratory study, four animated narratives of different genres were professionally generated. Children (N=41) between the ages of 8 and 12 years were interviewed to identify their preferences. Sessions were digitally recorded, transcribed, and analyzed using exploratory thematic analysis. Results Findings revealed that the children rated the dystopian science fiction story as their favorite across all weight, race, and gender groups. The physical activity-friendly narrative strategies included virtuous characters, extraordinary character actions, interesting plots, super powers, and engaging cliffhangers. Alternatively, information not related to physical activity, difficult-to-follow plot lines, passive protagonists, and repetitive narrative tropes were less appealing for physical activity. Conclusions This research provides preliminary evidence that narratives have characteristics that may increase child physical activity when playing active games. Future empirical studies should verify and test these design principles.
Collapse
Affiliation(s)
- Amy Shirong Lu
- Health Technology Lab, College of Arts, Media, and Design, Bouvé College of Health Sciences, Northeastern University, Boston, MA, United States
| | - Melanie C Green
- Department of Communication, State University of New York at Buffalo, Buffalo, NY, United States
| | - Debbe Thompson
- Children's Nutrition Research Center, Baylor College of Medicine, US Department of Agriculture, Houston, TX, United States
| |
Collapse
|
11
|
Cheng VWS, Davenport T, Johnson D, Vella K, Hickie IB. Gamification in Apps and Technologies for Improving Mental Health and Well-Being: Systematic Review. JMIR Ment Health 2019; 6:e13717. [PMID: 31244479 PMCID: PMC6617915 DOI: 10.2196/13717] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 05/22/2019] [Accepted: 05/29/2019] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND There is little research on the application of gamification to mental health and well-being. Furthermore, usage of gamification-related terminology is inconsistent. Current applications of gamification for health and well-being have also been critiqued for adopting a behaviorist approach that relies on positive reinforcement and extrinsic motivators. OBJECTIVE This study aimed to analyze current applications of gamification for mental health and well-being by answering 3 research questions (RQs). RQ1: which gamification elements are most commonly applied to apps and technologies for improving mental health and well-being? RQ2: which mental health and well-being domains are most commonly targeted by these gamified apps and technologies? RQ3: what reasons do researchers give for applying gamification to these apps and technologies? A systematic review of the literature was conducted to answer these questions. METHODS We searched ACM Digital Library, CINAHL, Cochrane Library, EMBASE, IEEE Explore, JMIR, MEDLINE, PsycINFO, PubMed, ScienceDirect, Scopus, and Web of Science for qualifying papers published between the years 2013 and 2018. To answer RQ1 and RQ2, papers were coded for gamification elements and mental health and well-being domains according to existing taxonomies in the game studies and medical literature. During the coding process, it was necessary to adapt our coding frame and revise these taxonomies. Thematic analysis was conducted to answer RQ3. RESULTS The search and screening process identified 70 qualifying papers that collectively reported on 50 apps and technologies. The most commonly observed gamification elements were levels or progress feedback, points or scoring, rewards or prizes, narrative or theme, personalization, and customization; the least commonly observed elements were artificial assistance, unlockable content, social cooperation, exploratory or open-world approach, artificial challenge, and randomness. The most commonly observed mental health and well-being domains were anxiety disorders and well-being, whereas the least commonly observed domains were conduct disorder and bipolar disorders. Researchers' justification for applying gamification to improving mental health and well-being was coded in 59% (41/70) of the papers and was broadly divided into 2 themes: (1) promoting engagement and (2) enhancing an intervention's intended effects. CONCLUSIONS Our findings suggest that the current application of gamification to apps and technologies for improving mental health and well-being does not align with the trend of positive reinforcement critiqued in the greater health and well-being literature. We also observed overlap between the most commonly used gamification techniques and existing behavior change frameworks. Results also suggest that the application of gamification is not driven by health behavior change theory, and that many researchers may treat gamification as a black box without consideration for its underlying mechanisms. We call for the inclusion of more comprehensive and explicit descriptions of how gamification is applied and the standardization of applied games terminology within and across fields.
Collapse
Affiliation(s)
| | - Tracey Davenport
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - Daniel Johnson
- Queensland University of Technology, Brisbane, Australia
| | - Kellie Vella
- Queensland University of Technology, Brisbane, Australia
| | - Ian B Hickie
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| |
Collapse
|
12
|
Schwarz A, Mertens L, Simons M, Spook JE, Thompson D, Cardon G, De Bourdeaudhuij I, Chastin SF, DeSmet A. Which Game Narratives Do Adolescents of Different Gameplay and Sociodemographic Backgrounds Prefer? A Mixed-Methods Analysis. Games Health J 2019; 8:195-204. [DOI: 10.1089/g4h.2017.0178] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ayla Schwarz
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | - Lieze Mertens
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
- Research Foundation Flanders, Brussels, Belgium
| | - Monique Simons
- Department of Human Geography and Spatial Planning, Utrecht University, Utrecht, The Netherlands
| | - Jorinde E. Spook
- Department of Communication, Philosophy and Technology, Centre for Integrative Development, Wageningen University, Wageningen, The Netherlands
| | - Debbe Thompson
- USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, Texas
| | - Greet Cardon
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | | | - Sebastien F.M. Chastin
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
- Institute for Applied Health Research, School of Health and Life Science, Glasgow Caledonian University, Scotland, United Kingdom
| | - Ann DeSmet
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
- Research Foundation Flanders, Brussels, Belgium
| |
Collapse
|
13
|
Winskell K, Sabben G, Obong'o C. Interactive Narrative in a Mobile Health Behavioral Intervention (Tumaini): Theoretical Grounding and Structure of a Smartphone Game to Prevent HIV Among Young Africans. JMIR Serious Games 2019; 7:e13037. [PMID: 31066692 PMCID: PMC6530263 DOI: 10.2196/13037] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 03/12/2019] [Accepted: 03/30/2019] [Indexed: 01/14/2023] Open
Abstract
The increasing availability of smartphones, including in low-income countries, offers an unprecedented opportunity to reach individuals with innovative health promotion interventions. Electronic games delivered via smartphone offer promising avenues for sexual health promotion and HIV prevention, especially for young people. By giving players real agency in a virtual and safe environment, well-designed games can provide a level of experiential learning unparalleled by many other behavioral interventions. The design of effective games for health relies on multidisciplinary insight and expertise. However, relatively few studies discuss the theoretical understanding underlying their intervention. Making explicit the theoretical grounding of a game-based intervention allows articulation of assumptions and strategies, anticipation of outcomes, and evaluation of impacts (including intermediate effects), thereby increasing understanding of pathways to change, with a view to contributing to the development of more effective games. It also helps strengthen the credibility and improve the accountability of games for health. We present the multidisciplinary theoretical framework-integrating intervention design, mediators, and behavioral outcomes-and the structure of an HIV prevention game for young African adolescents that has shown promise in a randomized pilot study in Western Kenya. The central component of Tumaini (hope for the future in Kiswahili) is an interactive role-playing narrative in which the player makes choices for characters that determine how their paths unfold. In addition, a series of mini-games reinforce skills, and the "My Story" component links the game world to the player's own life and goals, and a reward system motivates continued play. With its "choose-your-own-adventure" format, Tumaini is intended to be replayed so that players can experience the consequences resulting from different choices made in the role-playing narrative. Grounded in theories of narrative and applied communication and in social behavioral theories, especially Social Cognitive Theory, Tumaini is designed to help young adolescents acquire the information, skills, and motivation they need to avoid and reduce sexual risks. We close by situating Tumaini within discussion of the theory and practice of using interactive narrative in health promotion, with a view to furthering theoretical elaboration.
Collapse
Affiliation(s)
- Kate Winskell
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Gaëlle Sabben
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | | |
Collapse
|
14
|
|
15
|
Baranowski T, Blumberg F, Buday R, DeSmet A, Fiellin LE, Green CS, Kato PM, Lu AS, Maloney AE, Mellecker R, Morrill BA, Peng W, Shegog R, Simons M, Staiano AE, Thompson D, Young K. Games for Health for Children-Current Status and Needed Research. Games Health J 2015; 5:1-12. [PMID: 26262772 DOI: 10.1089/g4h.2015.0026] [Citation(s) in RCA: 154] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Videogames for health (G4H) offer exciting, innovative, potentially highly effective methods for increasing knowledge, delivering persuasive messages, changing behaviors, and influencing health outcomes. Although early outcome results are promising, additional research is needed to determine the game design and behavior change procedures that best promote G4H effectiveness and to identify and minimize possible adverse effects. Guidelines for ideal use of different types of G4H by children and adolescents should be elucidated to enhance effectiveness and minimize adverse effects. G4H stakeholders include organizational implementers, policy makers, players and their families, researchers, designers, retailers, and publishers. All stakeholders should be involved in G4H development and have a voice in setting goals to capitalize on their insights to enhance effectiveness and use of the game. In the future, multiple targeted G4H should be available to meet a population's diverse health needs in developmentally appropriate ways. Substantial, consistent, and sophisticated research with appropriate levels of funding is needed to realize the benefits of G4H.
Collapse
Affiliation(s)
- Tom Baranowski
- 1 USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine , Houston, Texas
| | - Fran Blumberg
- 2 Division of Psychological and Educational Services, Fordham University Graduate School of Education , New York, New York
| | | | - Ann DeSmet
- 4 Department of Movement and Sport Sciences, Ghent University , Ghent, Belgium
| | - Lynn E Fiellin
- 5 play2PREVENT Lab, Department of Internal Medicine, Yale University School of Medicine , New Haven, Connecticut
| | - C Shawn Green
- 6 Department of Psychology, University of Wisconsin , Madison, Wisconsin
| | - Pamela M Kato
- 7 Serious Games Institute, Coventry University , Coventry, United Kingdom
| | - Amy Shirong Lu
- 8 Departments of Communication Studies and Health Sciences, Northeastern University , Boston, Massachusetts
| | - Ann E Maloney
- 9 Department of Psychiatry, University of Massachusetts Medical School , Worcester, Massachusetts
| | - Robin Mellecker
- 10 Centre for Physical Activity & Nutrition Research, School of Exercise and Nutrition Sciences, Faculty of Health, Deakin University , Melbourne, Australia
| | | | - Wei Peng
- 12 Department of Telecommunications, Information Studies and Media, Michigan State University , East Lansing, Michigan
| | - Ross Shegog
- 13 Center for Health Promotion and Prevention Research, University of Texas School of Public Health , Houston, Texas
| | - Monique Simons
- 14 Department of Human Geography and Spatial Planning, Utrecht University , Utrecht, The Netherlands
| | - Amanda E Staiano
- 15 Pennington Biomedical Research Center, Louisiana State University , Baton Rouge, Louisiana
| | - Debbe Thompson
- 1 USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine , Houston, Texas
| | - Kimberly Young
- 16 Russell J. Jandoli School of Journalism & Mass Communication, St. Bonaventure University , New York
| |
Collapse
|