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Lu AS, Green MC, Alon D. The effect of animated Sci-Fi characters' racial presentation on narrative engagement, wishful identification, and physical activity intention among children. THE JOURNAL OF COMMUNICATION 2024; 74:160-172. [PMID: 38596345 PMCID: PMC11001265 DOI: 10.1093/joc/jqad030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 05/24/2023] [Accepted: 08/21/2023] [Indexed: 04/11/2024]
Abstract
Characters play an integral role in animated narratives, but their visual racial presentation has received limited attention. A diverse group of U.S. children watched a 15-min physical activity-promoting animated Sci-Fi narrative. They were randomly assigned to one of three conditions, which varied the lead characters' racial presentation: realistic racially unambiguous (Original: White children, Black mother), realistic racially ambiguous (Ambiguous: All with brown skin without specified race/ethnicity), and fantastical racially ambiguous (Fantastical: All with brown skin with fantastical hair-and-eye color schemes). We assessed narrative engagement, wishful identification, and physical activity intention. Controlling for social desirability and multigroup ethnic identity, children who watched Fantastical characters showed significantly higher narrative engagement than those who watched Original characters, but they did not statistically differ from those who watched Ambiguous characters. Structural equation modeling indicated that narrative engagement and wishful identification fully mediated the racial representation effect (Fantastical vs. Original) on physical activity intention.
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Affiliation(s)
- Amy Shirong Lu
- Health Technology Lab, Department of Communication Studies, College of Arts, Media, and Design, Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, MA 02115, USA
| | - Melanie C Green
- Department of Communication, University at Buffalo, Buffalo, NY 14260, USA
| | - Dar Alon
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA
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2
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Tolks D, Schmidt JJ, Kuhn S. The Role of AI in Serious Games and Gamification for Health: Scoping Review. JMIR Serious Games 2024; 12:e48258. [PMID: 38224472 PMCID: PMC10825760 DOI: 10.2196/48258] [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: 04/19/2023] [Revised: 10/12/2023] [Accepted: 10/18/2023] [Indexed: 01/16/2024] Open
Abstract
BACKGROUND Artificial intelligence (AI) and game-based methods such as serious games or gamification are both emerging technologies and methodologies in health care. The merging of the two could provide greater advantages, particularly in the field of therapeutic interventions in medicine. OBJECTIVE This scoping review sought to generate an overview of the currently existing literature on the connection of AI and game-based approaches in health care. The primary objectives were to cluster studies by disease and health topic addressed, level of care, and AI or games technology. METHODS For this scoping review, the databases PubMed, Scopus, IEEE Xplore, Cochrane Library, and PubPsych were comprehensively searched on February 2, 2022. Two independent authors conducted the screening process using Rayyan software (Rayyan Systems Inc). Only original studies published in English since 1992 were eligible for inclusion. The studies had to involve aspects of therapy or education in medicine and the use of AI in combination with game-based approaches. Each publication was coded for basic characteristics, including the population, intervention, comparison, and outcomes (PICO) criteria; the level of evidence; the disease and health issue; the level of care; the game variant; the AI technology; and the function type. Inductive coding was used to identify the patterns, themes, and categories in the data. Individual codings were analyzed and summarized narratively. RESULTS A total of 16 papers met all inclusion criteria. Most of the studies (10/16, 63%) were conducted in disease rehabilitation, tackling motion impairment (eg, after stroke or trauma). Another cluster of studies (3/16, 19%) was found in the detection and rehabilitation of cognitive impairment. Machine learning was the main AI technology applied and serious games the main game-based approach used. However, direct interaction between the technologies occurred only in 3 (19%) of the 16 studies. The included studies all show very limited quality evidence. From the patients' and healthy individuals' perspective, generally high usability, motivation, and satisfaction were found. CONCLUSIONS The review shows limited quality of evidence for the combination of AI and games in health care. Most of the included studies were nonrandomized pilot studies with few participants (14/16, 88%). This leads to a high risk for a range of biases and limits overall conclusions. However, the first results present a broad scope of possible applications, especially in motion and cognitive impairment, as well as positive perceptions by patients. In future, the development of adaptive game designs with direct interaction between AI and games seems promising and should be a topic for future reviews.
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Affiliation(s)
- Daniel Tolks
- Department of Digital Medicine, Medical Faculty OWL, Bielefeld University, Bielefeld, Germany
- Centre for Applied Health Science, Leuphana University Lueneburg, Lueneburg, Germany
| | - Johannes Jeremy Schmidt
- Department of Digital Medicine, Medical Faculty OWL, Bielefeld University, Bielefeld, Germany
| | - Sebastian Kuhn
- Department of Digital Medicine, Medical Faculty OWL, Bielefeld University, Bielefeld, Germany
- Institute for Digital Medicine, University Clinic of Gießen und Marburg, Philipps University Marburg, Marburg, Germany
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Bialy SE, Mohammad I. Some perspectives on designing effective serious games. CANADIAN MEDICAL EDUCATION JOURNAL 2023; 14:147-148. [PMID: 38045072 PMCID: PMC10689990 DOI: 10.36834/cmej.75475] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Affiliation(s)
- Safaa El Bialy
- Department of Innovation in Medical Education (DIME), Faculty of Medicine, University of Ottawa, Ontario, Canada
| | - Ibrahim Mohammad
- Department of Innovation in Medical Education (DIME), Faculty of Medicine, University of Ottawa, Ontario, Canada
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Dias C, Nery JTC, Hounsell MDS, Leal AB. A Multimodal Software Architecture for Serious Exergames and Its Use in Respiratory Rehabilitation. SENSORS (BASEL, SWITZERLAND) 2023; 23:8870. [PMID: 37960567 PMCID: PMC10650421 DOI: 10.3390/s23218870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/15/2023] [Accepted: 08/16/2023] [Indexed: 11/15/2023]
Abstract
Serious Exergames (SEGs) have been little concerned with flexibility/equivalence, complementarity, and monitoring (functionalities of systems that deal with a wide variety of inputs). These functionalities are necessary for health SEGs due to the variety of treatments and measuring requirements. No known SEG architectures include these three functionalities altogether. In this paper, we present the 123-SGR software architecture for the creation of an SEG that is appropriate to the needs of professionals and patients in the area of rehabilitation. An existing SEG was adapted and therapy-related sensor devices (Pneumotachograph, Manovacuometer, Pressure Belt, and Oximeter) were built to help the patient interact with the SEG. The architecture allows the most varied input combinations, with and without fusion, and these combinations are possible for both conscious and unconscious signals. Health and Technology professionals have assessed the SEG and found that it had the functionalities of flexibility/equivalence, complementarity, and monitoring, and that these are really important and necessary functionalities. The 123-SGR architecture can be used as a blueprint for future SEG development.
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Affiliation(s)
- Claudinei Dias
- Department of Electrical Engineering, Santa Catarina State University, Joinville 89219-710, Brazil; (J.T.C.N.); (M.d.S.H.); (A.B.L.)
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Conceição Gomes Lourenço MD, Fernandes CS, Campos Vale MBR. The use of games by nurses in palliative care: a scoping review. Int J Palliat Nurs 2023; 29:58-65. [PMID: 36822613 DOI: 10.12968/ijpn.2023.29.2.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Background: Nursing is at the forefront of palliative care. Games are an innovative strategy in palliative care training. Aims: This study aimed to examine the usefulness of games for nurses in palliative care. Methods: A scoping review was conducted using the following databases: CINAHL and PUBMED (which includes MEDLINE, PsycINFO, SCOPUS and SciELO). The steps outlined by the Joanna Briggs Institute were followed. Findings: Of the 685 articles initially identified, 17 were included for analysis. Games used were role-play (n=12), card games (n=1), digital games (n=1), board games (n=1), reflection games (n=1) and experimental games (n=1). Games were aimed at nurses (n=6) and nursing students (n= 1 1). Game advantages included: improved palliative care knowledge, increased communication skills, reduced negative emotions and increased multidisciplinary team skills. Conclusions: Effective and innovative pedagogical techniques are required training techniques for nurses and nursing students who provide palliative care, as they can reduce negative emotions such as fear, anguish and guilt.
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Affiliation(s)
| | - Carla Sílvia Fernandes
- Associate Professor, Nursing School of Porto; Center for Health Technology and Services Research (CINTESIS), Portugal
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Lu AS, Pelarski V, Alon D, Baran A, McGarrity E, Swaminathan N, Sousa CV. The effect of narrative element incorporation on physical activity and game experience in active and sedentary virtual reality games. VIRTUAL REALITY 2023; 27:1-16. [PMID: 36742343 PMCID: PMC9888740 DOI: 10.1007/s10055-023-00754-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 01/09/2023] [Indexed: 06/18/2023]
Abstract
Narratives are pervasive in video games and have been found to increase physical activity in active video games. However, the effect of incorporating narrative elements has seldom been examined in fully immersive virtual reality games. We investigated the effect of narrative element incorporation (between-subject: narrative vs. no narrative) in active virtual reality and sedentary virtual reality games (within-subject) and examined between- and within-subject effects on physical activity behavior, game experience, and physical activity engagement. We randomized 36 sedentary college students to either the narrative or the non-narrative group. All participants played an active virtual reality and a sedentary virtual reality game in counter-balanced order. Before each game session, they either watched a 5-min narrative video (narrative) or directly played the original virtual reality games without narratives (non-narrative). We collected participants' physical activity data using wrist-worn accelerometers; we obtained their game experience and physical activity engagement via questionnaires. The narrative group spent a greater proportion of time in moderate-to-vigorous physical activity (%) and had less non-movement time during the active virtual reality gameplay than the non-narrative group (all p values < .05). The active virtual reality sessions induced a greater positive affect and greater physical activity engagement ratings than the sedentary virtual reality sessions. The incorporation of narrative elements in active virtual reality increased the relative time spent in moderate-to-vigorous physical activity and reduced non-movement time, compared to the non-narrative group. Active virtual reality encouraged more activity by participants and offered them a more enjoyable gaming experience in which they engaged more. Active virtual reality is a feasible physical activity promotion option among sedentary adults; the incorporation of narrative elements in active virtual reality helps increase relative moderate-to-vigorous physical activity and should be further explored for its efficacy. Supplementary Information The online version contains supplementary material available at 10.1007/s10055-023-00754-7.
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Affiliation(s)
- Amy Shirong Lu
- Health Technology Lab, College of Arts, Media and Design, Bouvé College of Health Sciences, Northeastern University, Boston, MA 02115 USA
| | - Victoria Pelarski
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205 USA
| | - Dar Alon
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA 02115 USA
| | - Aleksandra Baran
- Health Technology Lab, College of Arts, Media and Design, Bouvé College of Health Sciences, Northeastern University, Boston, MA 02115 USA
| | - Emma McGarrity
- Health Technology Lab, College of Arts, Media and Design, Bouvé College of Health Sciences, Northeastern University, Boston, MA 02115 USA
| | - Neha Swaminathan
- Health Technology Lab, College of Arts, Media and Design, Bouvé College of Health Sciences, Northeastern University, Boston, MA 02115 USA
| | - Caio Victor Sousa
- Health and Human Sciences, Frank R. Seaver College of Science and Engineering, Loyola Marymount University, Los Angeles, CA 90045 USA
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7
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Martin P, Chapoton B, Bourmaud A, Dumas A, Kivits J, Eyraud C, Dubois C, Alberti C, Le Roux E. Health Promotion in Popular Online Community Games among Young People: Proposals, Recommendations and Applications (Preprint). JMIR Serious Games 2022. [DOI: 10.2196/39465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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8
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Robertson MC, Baranowski T, Thompson D, Basen-Engquist KM, Swartz MC, Lyons EJ. Using the Behaviour Change Wheel Program Planning Model to Design Games for Health: Development Study. JMIR Serious Games 2021; 9:e29964. [PMID: 34870604 PMCID: PMC8686484 DOI: 10.2196/29964] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 07/20/2021] [Accepted: 08/03/2021] [Indexed: 11/23/2022] Open
Abstract
Background Games for health are a promising approach to health promotion. Their success depends on achieving both experiential (game) and instrumental (health) objectives. There is little to guide game for health (G4H) designers in integrating the science of behavior change with the art of game design. Objective The aim of this study is to extend the Behaviour Change Wheel program planning model to develop Challenges for Healthy Aging: Leveraging Limits for Engaging Networked Game-Based Exercise (CHALLENGE), a G4H centered on increasing physical activity in insufficiently active older women. Methods We present and apply the G4H Mechanics, Experiences, and Change (MECHA) process, which supplements the Behaviour Change Wheel program planning model. The additional steps are centered on identifying target G4H player experiences and corresponding game mechanics to help game designers integrate design elements and G4H objectives into behavioral interventions. Results We identified a target behavior of increasing moderate-intensity walking among insufficiently active older women and key psychosocial determinants of this behavior from self-determination theory (eg, autonomy). We used MECHA to map these constructs to intervention functions (eg, persuasion) and G4H target player experiences (eg, captivation). Next, we identified behavior change techniques (eg, framing or reframing) and specific game mechanics (eg, transforming) to help realize intervention functions and elicit targeted player experiences. Conclusions MECHA can help researchers map specific linkages between distal intervention objectives and more proximal game design mechanics in games for health. This can facilitate G4H program planning, evaluation, and clearer scientific communication.
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Affiliation(s)
- Michael C Robertson
- Department of Nutrition, Metabolism & Rehabilitation Sciences, University of Texas Medical Branch at Galveston, Galveston, TX, United States
| | - Tom Baranowski
- U.S. Department of Agriculture/Agricultural Research Service Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX, United States
| | - Debbe Thompson
- U.S. Department of Agriculture/Agricultural Research Service Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX, United States
| | - Karen M Basen-Engquist
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Maria Chang Swartz
- Department of Pediatrics-Research, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Elizabeth J Lyons
- Department of Nutrition, Metabolism & Rehabilitation Sciences, University of Texas Medical Branch at Galveston, Galveston, TX, United States
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9
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Dadaczynski K, Krah V, Frank D, Zügel-Hintz E, Pöhlmann F. Promoting Navigation Health Literacy at the Intersection of Schools and Communities. Development of the Game-Based Intervention Nebolus. Front Public Health 2021; 9:752183. [PMID: 34869169 PMCID: PMC8635644 DOI: 10.3389/fpubh.2021.752183] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 10/26/2021] [Indexed: 11/13/2022] Open
Abstract
Emerging empirical evidence indicates a limited health literacy for a substantial proportion of children and adolescents. Although it is generally agreed upon promoting health literacy as early as possible in the lifespan, there is a lack of interventions addressing children and adolescents and their primary living environments. This article describes the development of Nebolus, a game-based intervention aiming to promote navigation health literacy at the intersection of schools and communities. Its intervention foundation lies in a socio-ecological understanding of health as well as in the Entertainment Education approach. Following an extensive literature search on health-related location-based games, a co-creation process was initiated that involved adolescents, community stakeholders, and design/IT professionals in all phases of the intervention development. The final Nebolus intervention includes three core activities: (1) a Nebolus rally app for adolescents aged 12 to 16 years, (2) an online planning tool allowing local health service providers/professionals to set up own Nebolus rallies, and (3) accompanying teaching material on health literacy in the school setting to be used before and after the Nebolus rallies. This article provides an overview of the intervention layout and discusses strengths and challenges of its development and implementation.
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Affiliation(s)
- Kevin Dadaczynski
- Department of Nursing and Health Science, Fulda University of Applied Sciences, Fulda, Germany
- Centre for Applied Health Science, Leuphana University Lueneburg, Lueneburg, Germany
| | - Verena Krah
- Department of Nursing and Health Science, Fulda University of Applied Sciences, Fulda, Germany
| | - Demian Frank
- Department of Nursing and Health Science, Fulda University of Applied Sciences, Fulda, Germany
| | - Elisabeth Zügel-Hintz
- Department of Nursing and Health Science, Fulda University of Applied Sciences, Fulda, Germany
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10
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Vieira C, Ferreira da Silva Pais-Vieira C, Novais J, Perrotta A. Serious Game Design and Clinical Improvement in Physical Rehabilitation: Systematic Review. JMIR Serious Games 2021; 9:e20066. [PMID: 34554102 PMCID: PMC8498892 DOI: 10.2196/20066] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 02/23/2021] [Accepted: 06/05/2021] [Indexed: 01/03/2023] Open
Abstract
Background Serious video games have now been used and assessed in clinical protocols, with several studies reporting patient improvement and engagement with this type of therapy. Even though some literature reviews have approached this topic from a game perspective and presented a broad overview of the types of video games that have been used in this context, there is still a need to better understand how different game characteristics and development strategies might impact and relate to clinical outcomes. Objective This review assessed the relationship between the characteristics of serious games (SGs) and their relationship with the clinical outcomes of studies that use this type of therapy in motor impairment rehabilitation of patients with stroke, multiple sclerosis, or cerebral palsy. The purpose was to take a closer look at video game design features described in the literature (game genre [GG], game nature [GN], and game development strategy [GDS]) and assess how they may contribute toward improving health outcomes. Additionally, this review attempted to bring together medical and game development perspectives to facilitate communication between clinicians and game developers, therefore easing the process of choosing the video games to be used for physical rehabilitation. Methods We analyzed the main features of SG design to obtain significant clinical outcomes when applied to physical rehabilitation of patients recovering from motor impairments resulting from stroke, multiple sclerosis, and cerebral palsy. We implemented a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) database-adjusted electronic search strategy for the PubMed, IEEE Xplore, and Cochrane databases. Results We screened 623 related papers from 2010-2021 and identified 12 that presented results compatible with our inclusion criteria. A total of 512 participants with stroke (8 studies, 417 participants), cerebral palsy (1 study, 8 participants), and multiple sclerosis (2 studies, 46 participants) were included; 1 study targeting the elderly (41 participants) was also included. All studies assessed motor, sensory, and functional functions, while some also measured general health outcomes. Interventions with games were used for upper-limb motor rehabilitation. Of the 12 studies, 8 presented significant improvements in at least one clinical measurement, of which 6 presented games from the casual GG, 1 combined the casual, simulation, and exergaming GGs, and 2 combined the sports and simulation GGs. Conclusions Of the possible combinations of game design features (GG, GN, and GDS) described, custom-made casual games that resort to the first-person perspective, do not feature a visible player character, are played in single-player mode, and use nonimmersive virtual reality attain the best results in terms of positive clinical outcomes. In addition, the use of custom-made games versus commercial off-the-shelf games tends to give better clinical results, although the latter are perceived as more motivating and engaging.
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Affiliation(s)
- Catarina Vieira
- Research Center for Science and Technology of the Arts, Universidade Católica Portuguesa, Porto, Portugal
| | | | - João Novais
- Católica Porto Business School, Universidade Católica Portuguesa, Porto, Portugal
| | - André Perrotta
- Research Center for Science and Technology of the Arts, Universidade Católica Portuguesa, Porto, Portugal.,Research Centre for Informatics and Systems, Informatics Engineering Department, Universidade de Coimbra, Coimbra, Portugal
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Ferreira-Brito F, Ribeiro F, Aguiar de Sousa D, Costa J, Caneiras C, Carriço L, Verdelho A. Are Video Games Effective to Promote Cognition and Everyday Functional Capacity in Mild Cognitive Impairment/Dementia Patients? A Meta-Analysis of Randomized Controlled Trials. J Alzheimers Dis 2021; 84:329-341. [PMID: 34542073 DOI: 10.3233/jad-210545] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Mild cognitive impairment (MCI) and dementia are associated with increased age. MCI is a clinical entity described as a transitional state between normal cognition and dementia. Video games (VGs) can potentially promote cognition and functional capacity since multiple cognitive domains are recruited during gameplay. However, there is still a lack of consensus regarding the efficacy of VGs as therapeutic tools, particularly in neurodegenerative diseases. OBJECTIVE We aimed to analyze the impact of VGs on cognition and functional capacity outcomes in MCI/dementia patients. METHODS We conducted a systematic review and meta-analysis study (PROSPERO [CRD42021229445]). PubMed, Web of Science, Epistemonikos, CENTRAL, and EBSCO electronic databases were searched for RCT (2000-2021) that analyzed the impact of VGs on cognitive and functional capacity outcomes in MCI/dementia patients. RESULTS Nine studies were included (n = 409 participants), and Risk of Bias (RoB2) and quality of evidence (GRADE) were assessed. Data regarding attention, memory/learning, visual working memory, executive functions, general cognition, functional capacity, quality of life were identified, and pooled analyses were conducted. An effect favoring VGs interventions was observed on Mini-Mental State Examination (MMSE) score (MD = 1.64, 95%CI 0.60 to 2.69). CONCLUSION Although promising, the effects observed should be interpreted with caution since serious methodological shortcomings were identified in the studies included. Nonetheless, the effect observed is higher than the minimum clinically important difference (1.4 points) established to MMSE. Future studies on the current topic urge. Recommendations for the design and conduction of cognitive RCT studies are presented.
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Affiliation(s)
- Filipa Ferreira-Brito
- Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Filipa Ribeiro
- Center for Interdisciplinary Research in Health, Instituto de Ciências da Saúde, Universidade Católica Portuguesa, Lisbon, Portugal
| | - Diana Aguiar de Sousa
- Department of Neurosciences (Neurology), Hospital de Santa Maria, University of Lisboa, Lisbon, Portugal
| | - João Costa
- Centro de Estudos de Medicina Baseada na Evidência, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Centro Colaborador Português da Rede Cochrane Iberoamericana, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Laboratório de Farmacologia Clínica e Terapêutica, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Cátia Caneiras
- Laboratório de Investigação em Microbiologia na Saúde Ambiental (EnviHealthMicro Lab), Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Healthcare Department, Nippon Gases Portugal, Vila Franca de Xira, Portugal
| | - Luís Carriço
- LASIGE, Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal
| | - Ana Verdelho
- Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Neurology Service, Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
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12
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Tan NC, Koh YLE, Goh CC, Ngoh SHA, Tan AM, Sankari U, Lee SB, Tay HCD, Lim SH. An innovation involving self-surveillance and serious gaming to increase smoking quit rate: Protocol for a pilot randomized controlled trial. Tob Prev Cessat 2021; 7:57. [PMID: 34395954 PMCID: PMC8330840 DOI: 10.18332/tpc/138950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 05/10/2021] [Accepted: 06/14/2021] [Indexed: 11/24/2022]
Abstract
Smoking is a health hazard. Current smoking cessation measures such as behavioral change counselling by trained professionals, nicotine replacement therapy and medications have limited success. Smoking intensity is assessed using a portable device to measure the smokers’ exhaled breath carbon monoxide (eCO) level. A systematic review suggests the potential of serious gaming to increase smoking quit rate. However, the related studies were unable to explain and determine the effect gamification on smoking cessation. A handy personalized eCO measurement device linked to a smart-phone applications (app) has been developed (integrated STEADES-2 system). This novel system incorporates app-based video and print learning resources, authentication function and gamification using the eCO data as game element. Trained multidisciplinary healthcare professionals access the STEADES-2 data to monitor smoking status and support smokers via asynchronous virtual coaching. The pilot randomized controlled trial will enroll 20 smokers to use the STEADES-2 system (intervention group) and another 20 to the existing smoking cessation programme (control group) in primary care. The primary feasibility outcomes will include the recruitment response rate, the smokers’ usability of the STEADES-2 system, their self eCO monitoring, frequencies of participation in the serious games and interactions with their virtual coaches. Their smoking literacy, utility and experience of the STEADES-2 system are other outcomes. Smokers in both groups will be compared on their cigarette abstinence as secondary outcome based on eCO levels and urine cotinine test (primary outcomes after 12 weeks). The results will be disseminated via conferences and publications.
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Affiliation(s)
- Ngiap C Tan
- SingHealth Polyclinics, Singapore.,SingHealth-Duke NUS, Family Medicine Academic Clinical Program, Singapore
| | | | | | | | - Ai M Tan
- SingHealth Polyclinics, Singapore
| | | | | | - Hong C D Tay
- Institute of Technical Education College West, Singapore
| | - Soon H Lim
- Institute of Technical Education College West, Singapore
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13
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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.
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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
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14
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Fernandes CS, Magalhães B, Goncalves F, Nogueira PC, Santos C. The Use of Gamification in Patients Undergoing Hip Arthroplasty: Scoping Review. Games Health J 2021; 10:147-157. [PMID: 33945335 DOI: 10.1089/g4h.2020.0210] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Objective: The use of gamification can promote health-related behavior. This article is the first attempt to provide a historical overview of the use of games in patients undergoing hip arthroplasty. Materials and Methods: We conducted a scoping review to map and characterize the games used for the person undergoing hip arthroplasty. To perform this review, the respective descriptors were identified using search syntax appropriate to each of the databases: MEDLINE_ (Medical Literature Analysis and Retrieval System Online), CINAHL_ (Cumulative Index to Nursing and Allied Health Literature), SPORTDiscus, in the Psychology and Behavioral Sciences Collection, SCOPUS, SciELO (Scientific Electronic Library Online), and PEDRo (Physiotherapy Evidence Database). Results: An initial 968 articles were identified, of which 7 articles were included. The domains of the games under analysis essentially focus on aspects of rehabilitation (n = 5), or related (n = 2), and mostly exergames (n = 6). However, the instruments, characteristics, and procedures used to evaluate the games in the included studies have little depth and large variability. Conclusion: Few games exist that support people who have undergone hip arthroplasty. Most of the games under review were exergames to support rehabilitation. Consequently, we recommend developing another type of game with a focus on monitoring, counseling, and/or social support for selfmanagement training in persons undergoing hip arthroplasty.
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Affiliation(s)
- Carla Sílvia Fernandes
- Nursing School of Porto, Porto, Portugal.,Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
| | - Bruno Magalhães
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal.,Santa Maria Health School, Porto, Portugal
| | - Filipe Goncalves
- Portuguese Association of Amyotrophic Lateral Sclerosis, Porto, Portugal
| | | | - Célia Santos
- Nursing School of Porto, Porto, Portugal.,Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
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15
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Jackman KMP, Kane J, Kharrazi H, Johnson RM, Latkin C. Using the Patient Portal Sexual Health Instrument in Surveys and Patient Questionnaires Among Sexual Minority Men in the United States: Cross-sectional Psychometric Validation Study. J Med Internet Res 2021; 23:e18750. [PMID: 33565987 PMCID: PMC7935249 DOI: 10.2196/18750] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 07/24/2020] [Accepted: 10/26/2020] [Indexed: 01/01/2023] Open
Abstract
Background Patient portal modules, including electronic personal health records, health education, and prescription refill ordering, may be leveraged to address the sexually transmitted infection (STI) burden, including HIV, among gay, bisexual, and other sexual minority men (SMM). Theoretical frameworks in the implementation sciences highlight examining constructs of innovation attributes and performance expectations as key determinants of behavioral intentions and the use of new web-based health technologies. However, behavioral intentions to use patient portals for HIV and other STI prevention and care among SMM is understudied. Objective The aim of this study is to develop a brief instrument for measuring attitudes focused on using patient portals for STI prevention and care among a nationwide sample of SMM. Methods A total of 12 items of the American Men’s Internet Survey-Patient Portal Sexual Health Instrument (AMIS-PPSHI) were adapted from a previous study. Psychometric analyses of the AMIS-PPSHI items were conducted among a randomized subset of 2018 AMIS participants reporting web-based access to their health records (N=1375). Parallel analysis and inspection of eigenvalues in a principal component analysis (PCA) informed factor retention in exploratory factor analysis (EFA). After EFA, Cronbach α was used to examine the internal consistency of the scale and its subscales. Confirmatory factor analysis (CFA) was used to assess the goodness of fit of the final factor structure. We calculated the total AMIS-PPSHI scale scores for comparisons within group categories, including age, STI diagnosis history, recency of testing, serious mental illness, and anticipated health care stigma. Results The AMIS-PPSHI scale resulting from EFA consisted of 12 items and had good internal consistency (α=.84). The EFA suggested 3 subscales: sexual health engagement and awareness (α=.87), enhancing dyadic communication (α=.87), and managing sexual health care (α=.79). CFA demonstrated good fit in the 3-factor PPSHI structure: root mean square error of approximation=0.061, comparative fit index=0.964, Tucker-Lewis index=0.953, and standardized root mean square residual=0.041. The most notable differences were lower scores on the enhanced dyadic communication subscale among people living with HIV. Conclusions PPSHI is a brief instrument with strong psychometric properties that may be adapted for use in large surveys and patient questionnaires in other settings. Scores demonstrate that patient portals are favorable web-based solutions to deliver health services focused on STI prevention and care among SMM in the United States. More attention is needed to address the privacy implications of interpersonal use of patient portals outside of traditional health settings among persons with HIV.
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Affiliation(s)
- Kevon-Mark P Jackman
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Jeremy Kane
- Department of Epidemiology, Columbia University Mailman School of Public Health, NY, NY, United States
| | - Hadi Kharrazi
- Department of Health Policy and Management, Center for Population Health IT, Johns Hopkins Bloomberg School of Public Health, Batimore, MD, United States
| | - Renee M Johnson
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Carl Latkin
- Department of Health, Behavior, and Society, Johns Hopkins Blooomberg School of Public Health, Baltimore, MD, United States
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16
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Espinosa-Curiel IE, Pozas-Bogarin EE, Martínez-Miranda J, Pérez-Espinosa H. Relationship Between Children's Enjoyment, User Experience Satisfaction, and Learning in a Serious Video Game for Nutrition Education: Empirical Pilot Study. JMIR Serious Games 2020; 8:e21813. [PMID: 32940609 PMCID: PMC7530690 DOI: 10.2196/21813] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/21/2020] [Accepted: 09/01/2020] [Indexed: 01/25/2023] Open
Abstract
Background The design and use of serious video games for children have increased in recent years. To maximize the effects of these games, it is essential to understand the children’s experiences through playing. Previous studies identified that enjoyment and user experience satisfaction of the players are principal factors that can influence the success of serious video games and the learning of their players. However, research about the relationship between enjoyment and user experience satisfaction with learning in children 8 to 10 years old is sparse. Objective We examined the relationship of enjoyment and user experience satisfaction with the learning of children aged 8 to 10 years while playing a serious video game for health, FoodRateMaster. This serious video game teaches children about the characteristics of healthy and unhealthy foods and how to identify them in their environment. Methods Children aged 8 to 10 years were recruited from a primary school in Mexico. Participants completed 12 individual gaming sessions with FoodRateMaster in 6 weeks. A food knowledge questionnaire was administered before and after game play to assess the players’ food knowledge. In addition, after the gaming sessions, the children’s enjoyment and user experience satisfaction were evaluated using the EGameFlow questionnaire and the Game User Experience Satisfaction Scale (GUESS) questionnaire. Results We found significant positive associations for children’s (n=60) posttest knowledge with enjoyment (r58=0.36, P=.005) and user experience satisfaction (r58=0.27, P=.04). The children’s posttest knowledge scores were also positively correlated with challenge (r58=0.38, P=.003), knowledge improvement (r58=0.38, P=.003), and goal clarity (r58=0.29, P=.02) EGameFlow subscales and with narrative (r58=0.35, P=.006), creative freedom (r58=0.26, P=.04), and visual esthetics (r58=0.32, P=.01) GUESS subscales. Regression analysis indicated that the EGameFlow (F7,52=2.74, P=.02, R2=0.27) and the GUESS (F8,51=2.20, P=.04, R2=0.26) ratings significantly predicted the children’s posttest knowledge scores. EGameFlow challenge (β=0.40, t52=2.17, P=.04) and knowledge improvement (β=0.29, t52=2.06, P=.04) subscales significantly contributed to predicting children’s learning. None of the GUESS subscales significantly contributed to predicting children’s learning. Conclusions The findings of this study suggest that both enjoyment and user experience satisfaction for children aged 8 to 10 years were positively correlated with their learning and that were significant predictors of it. Challenge, knowledge improvement, narrative, creative freedom, and visual esthetics subscales correlated positively with children’s learning. In addition, challenge and knowledge improvement contributed to predicting their learning. These results are relevant to consider during the design stages of serious games developed for young children’s learning purposes.
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Affiliation(s)
- Ismael Edrein Espinosa-Curiel
- Centro de Investigación Científica y de Educación Superior de Ensenada, Unidad de Transferencia Tecnológica Tepic, Tepic, Nayarit, Mexico
| | - Edgar Efrén Pozas-Bogarin
- Centro de Investigación Científica y de Educación Superior de Ensenada, Unidad de Transferencia Tecnológica Tepic, Tepic, Nayarit, Mexico
| | - Juan Martínez-Miranda
- Consejo Nacional de Ciencia y Tecnología, Centro de Investigación Científica y de Educación Superior de Ensenada, Unidad de Transferencia Tecnológica Tepic, Tepic, Nayarit, Mexico
| | - Humberto Pérez-Espinosa
- Consejo Nacional de Ciencia y Tecnología, Centro de Investigación Científica y de Educación Superior de Ensenada, Unidad de Transferencia Tecnológica Tepic, Tepic, Nayarit, Mexico
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17
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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.
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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.
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18
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Buijs-Spanjers KR, Harmsen A, Hegge HH, Spook JE, de Rooij SE, Jaarsma DADC. The influence of a serious game's narrative on students' attitudes and learning experiences regarding delirium: an interview study. BMC MEDICAL EDUCATION 2020; 20:289. [PMID: 32873285 PMCID: PMC7465326 DOI: 10.1186/s12909-020-02210-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 08/25/2020] [Indexed: 05/15/2023]
Abstract
BACKGROUND Delirium is a neuropsychiatric syndrome that affects patients' attention and awareness as a result of a physical condition. In recent years, persistent gaps in delirium education have led to suboptimal delirium care. Still, little is known about what are the most important aspects of effective delirium education. Serious games are both entertainment and an interactive, safe learning environment where players can experiment and create new knowledge. They have the potential to contribute to improved delirium education. We used a video-based serious games' narrative to explore aspects essential to enhance students' attitudes and learning experiences regarding delirium. METHODS We created a semi-structured interview guide and interviewed seven nursing and nine medical students about their attitudes and learning experiences, after they had played the game. A qualitative descriptive design and inductive content analysis with constant comparison were used. RESULTS The patient's and nurse's perspective, interactivity to experiment, realistic views on care options, and feedback on care actions were important for enhancing students' attitudes and learning experiences regarding delirium. Students felt these aspects encouraged them to get actively involved in and experiment with the study material, which in turn led to enhanced reflection on delirium care and education. Our findings highlight the importance of a more patient-oriented focus to delirium education to drive attitudinal change. Students' learning experiences were further enhanced through their affective responses provoked by the perspectives, interactivity, realism, and feedback. CONCLUSIONS Students considered the characters' perspectives, interactivity, realism, and feedback important aspects of the game to enhance their attitudes towards delirious patients and enrich their learning experiences. A patient-oriented narrative provides a clinically relevant experience in which reflection plays an important role. The serious game also serves as medium to actively experiment with care solutions to create better understanding of how healthcare professionals can influence a delirious patient's experience.
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Affiliation(s)
- Kiki R Buijs-Spanjers
- Department of Geriatric Medicine, University of Groningen, University Medical Center Groningen, PO Box 30001, HPC: AA43, Groningen, 9700 RB, The Netherlands.
- Center for Education Development and Research in Health Professions, LEARN, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Anne Harmsen
- Strategic Communication Group, Wageningen University, Wageningen, The Netherlands
| | - Harianne H Hegge
- Department of Geriatric Medicine, University of Groningen, University Medical Center Groningen, PO Box 30001, HPC: AA43, Groningen, 9700 RB, The Netherlands
- Center for Education Development and Research in Health Professions, LEARN, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jorinde E Spook
- Strategic Communication Group, Wageningen University, Wageningen, The Netherlands
| | - Sophia E de Rooij
- Department of Geriatric Medicine, University of Groningen, University Medical Center Groningen, PO Box 30001, HPC: AA43, Groningen, 9700 RB, The Netherlands
- Medical School Twente, Medical Spectrum Twente, Enschede, The Netherlands
| | - Debbie A D C Jaarsma
- Center for Education Development and Research in Health Professions, LEARN, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Ingadottir B, Jaarsma T, Klompstra L, Aidemark J, Askenäs L, Bahat Y, Ben Gal O, Berglund A, Berglund E, Höchsmann C, Plotnik M, Trappenburg JC, Schmidt-Trucksäss A, Strömberg A. Let the games begin: Serious games in prevention and rehabilitation to improve outcomes in patients with cardiovascular disease. Eur J Cardiovasc Nurs 2020; 19:558-560. [PMID: 32538132 DOI: 10.1177/1474515120934058] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Brynja Ingadottir
- University of Iceland and Landspitali - the National University Hospital of Iceland, Iceland
| | - Tiny Jaarsma
- Department of Health, Medicine and Caring Sciences, Linköping University, Sweden
| | - Leonie Klompstra
- Department of Health, Medicine and Caring Sciences, Linköping University, Sweden
| | - Jan Aidemark
- Department of Informatics, Linnaeus University, Sweden
| | - Linda Askenäs
- Department of Informatics, Linnaeus University, Sweden
| | - Yotam Bahat
- Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Israel
| | - Oran Ben Gal
- Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Israel
| | - Aseel Berglund
- Department of Computer and Information Science, Linköping University, Sweden
| | - Erik Berglund
- Department of Computer and Information Science, Linköping University, Sweden
| | - Christoph Höchsmann
- Pennington Biomedical Research Center, Ingestive Behavior, Weight Management & Health Promotion Laboratory, USA
| | - Meir Plotnik
- Center of Advanced Technologies in Rehabilitation, Sheba Medical Center, Israel.,Department of Physiology and Pharmacology, Tel Aviv University, Israel
| | - Jaap Ca Trappenburg
- Department of Public Health, Healthcare Innovation and Evaluation and Medical Humanities, Julius Center, The Netherlands
| | | | - Anna Strömberg
- Department of Health, Medicine and Caring Sciences, Linköping University, Sweden.,Department of Cardiology, Linköping University, Sweden
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20
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Smith CE, Yadrich D, Wright S, Ridder L, Werkowitch M, Bruce A, Bonar JRM. Themes of Stressors, Emotional Fatigue, and Communication Challenges Found in Mobile Care Discussion Sessions With Patients Requiring Lifelong Home Parenteral Nutrition Infusions. JPEN J Parenter Enteral Nutr 2020; 45:499-506. [PMID: 32495954 DOI: 10.1002/jpen.1854] [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] [Received: 02/21/2020] [Revised: 03/28/2020] [Accepted: 04/14/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND The purpose of this article is to examine themes and topics that emerged from 35 discussion sessions with teens and young adults requiring long-term home parenteral nutrition (HPN) intravenous infusions. The goal was to gain a more detailed understanding of participants' challenges and successes of living with HPN. METHODS These patients were invited to attend 3 discussion group sessions facilitated by health professionals. A secure iPad Mini was selected as the mobile tablet device for hosting these encrypted audio-visual group discussions. Content analysis, a standard research data-sorting technique, was used to summarize the anonymous data. Words, phrases, and topics in patients' discussions were coded and grouped together with similar concepts and subsequently categorized into themes. RESULTS Themes in these discussions were related to patients' daily, complex management of HPN. These "themes" included having multiple repetitive illness-related stressors and how those stressors were managed; managing emotions; communication challenges with professionals, family, friends, and using social media; and lastly, the least frequent but no less important theme discussed was how HPN effects their daily lives. CONCLUSION Teens and young adults living with lifelong HPN face a variety of unique psychological, physical, and emotional stressors and may benefit from numerous methods for managing these challenges.
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Affiliation(s)
- Carol E Smith
- School of Nursing, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Donna Yadrich
- School of Nursing, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Shawna Wright
- University of Kansas Center for Telemedicine & Telehealth, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Lavonne Ridder
- School of Nursing, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Marilyn Werkowitch
- School of Nursing, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Amanda Bruce
- Department of Pediatrics, University of Kansas Medical Center, Center for Children's Healthy Lifestyles and Nutrition, Kansas City, Kansas, USA
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21
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Holzmann SL, Schäfer H, Plecher DA, Stecher L, Klinker GJ, Groh G, Hauner H, Holzapfel C. Serious Games for Nutritional Education: Online Survey on Preferences, Motives, and Behaviors Among Young Adults at University. JMIR Serious Games 2020; 8:e16216. [PMID: 32490847 PMCID: PMC7301263 DOI: 10.2196/16216] [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] [Received: 09/11/2019] [Revised: 11/26/2019] [Accepted: 04/23/2020] [Indexed: 01/27/2023] Open
Abstract
Background Data on nutritional information and digital gameplay are limited among young adults in Germany. Objective This survey aimed to gather data on nutritional information sources and digital games for nutritional education (preferences, motives, and behaviors) among young adults at both Munich universities in Germany. Methods An online survey was developed by an multidisciplinary research group using EvaSys, an in-house survey software. The questionnaire (47 items) covered questions about baseline characteristics (eg, housing situation and weight), nutrition (eg, nutritional information sources), and digital (nutritional) gameplay (eg, preferences, motives, and behaviors). A feedback field was also provided. This publication is based on a selection of 20 questions (7 baseline characteristics, 2 nutrition, 11 gameplay). Young adults, primarily Munich university students aged from 18 to 24 years, were invited to participate by digital and nondigital communication channels between 2016 and 2017. Statistical analyses were performed using Excel 2013 (Microsoft Corp) and R version 3.1.3 (R Foundation for Statistical Computing). Results In total, 468 young adults (342/468, 73.1% women; 379/468, 81.0% university students) participated. Most of the participants (269/468, 57.5%) were aged 18 to 24 years with a BMI in the normal weight range (346/447, 77.4%). Mean body weight was 65.5 [SD 14.0] kg. Most participants reported getting nutritional information from the internet (372/467, 79.7%) and printed media (298/467, 63.8%), less than 1.0% (2/467, 0.4%) named digital games. Apps (100/461, 21.7%) and university/workplace (146/461, 31.7%) were the most desired sources for additional information about nutrition, while 10.0% (46/461, 10.0%) of participants stated wanting digital games. Almost two-thirds (293/468, 62.6%) of participants played digital games, while one-fifth (97/456, 21.3%) played digital games daily using smartphones or tablets. Finally, most respondents (343/468, 73.3%), mainly women, expressed interest in obtaining nutritional information during digital gameplay. However, significant gender differences were shown for nutritional acquisition behaviors and digital gameplay preferences, motives, and behaviors. Conclusions Our survey population reported playing digital games (especially men) and wanting nutritional information during digital gameplay (especially women). Furthermore, university or workplace are named as preferred settings for nutritional information. Therefore, a digital game app might have the potential to be a tool for nutritional education among young adults within the university or workplace environment.
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Affiliation(s)
- Sophie Laura Holzmann
- Institute for Nutritional Medicine, Else Kröner-Fresenius-Center for Nutritional Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | - Hanna Schäfer
- Research Group Social Computing, Department of Informatics, Technical University of Munich, Garching, Germany
| | - David Alexander Plecher
- Chair for Computer Aided Medical Procedures & Augmented Reality, Department of Informatics, Technical University of Munich, Garching, Germany
| | - Lynne Stecher
- Institute for Nutritional Medicine, Else Kröner-Fresenius-Center for Nutritional Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | - Gudrun Johanna Klinker
- Chair for Computer Aided Medical Procedures & Augmented Reality, Department of Informatics, Technical University of Munich, Garching, Germany
| | - Georg Groh
- Research Group Social Computing, Department of Informatics, Technical University of Munich, Garching, Germany
| | - Hans Hauner
- Institute for Nutritional Medicine, Else Kröner-Fresenius-Center for Nutritional Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | - Christina Holzapfel
- Institute for Nutritional Medicine, Else Kröner-Fresenius-Center for Nutritional Medicine, School of Medicine, Technical University of Munich, Munich, Germany
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Tolks D, Lampert C, Dadaczynski K, Maslon E, Paulus P, Sailer M. Spielerische Ansätze in Prävention und Gesundheitsförderung: Serious Games und Gamification. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2020; 63:698-707. [DOI: 10.1007/s00103-020-03156-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
ZusammenfassungDigitale Spieleanwendungen können im Bereich Prävention und Gesundheitsförderung eingesetzt werden, um etwa gesundheitsrelevante Informationen zu vermitteln oder Verhaltensänderungen zu evozieren. Dabei sind die beiden relevantesten spielerischen Ansätze Serious Games (Spiele mit ernsthaftem Hintergrund) und Gamification (Anwendung spieltypischer Elemente in spielfremden Kontexten). Der Begriff Serious Games umschreibt Spiele, die eingesetzt werden, um ernsthafte Inhalte, wie zum Beispiel gesundheitliche Themen, zu vermitteln. Bei Gamification werden Spieldesignelemente, wie beispielsweise Punkte, Bestenlisten, Auszeichnungen, Profilgestaltung und Teamevents, eingesetzt, um eine Motivations- und Leistungssteigerung etwa in Lernumgebungen zu bewirken. Der vorliegende narrative Beitrag beleuchtet die Wirkungsweise und Studienlage sowie die Vor- und Nachteile spielerischer Anwendungen in der Prävention und Gesundheitsförderung und führt einige dieser Anwendungen exemplarisch auf.Serious Games und Gamification zeigen in der Prävention und Gesundheitsförderung ein großes Potenzial. Insbesondere bei schwer erreichbaren und desinteressierten Zielgruppen kann ein direkter Bezug zu deren Lebenswelt hergestellt werden. Grundlagen für den wirkungsvollen Einsatz spielerischer Ansätze in der Arbeit und Ausbildung von Gesundheitsberufen sind die bereits hohe Vertrautheit mit dem Medium Spiel sowie die direkte Adressierung der psychologischen Grundbedürfnisse zur Steigerung der Motivation.
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Sousa CV, Fernandez A, Hwang J, Lu AS. The Effect of Narrative on Physical Activity via Immersion During Active Video Game Play in Children: Mediation Analysis. J Med Internet Res 2020; 22:e17994. [PMID: 32229466 PMCID: PMC7157497 DOI: 10.2196/17994] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 02/26/2020] [Accepted: 02/27/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Active video games (AVGs) can increase physical activity (PA) and help produce higher physiological expenditure. Animated narrative videos (NVs) possess unique immersive and motivational properties. When added to AVGs, they have been found to increase moderate-to-vigorous physical activity (MVPA) as opposed to the original no video condition. However, there is no evidence of whether that was due to the NV or the addition of an animated video to an AVG. OBJECTIVE This study aimed to investigate the differential effect of adding an NV versus a nonnarrative video (NNV) to an AVG on PA parameters and physiological responses and to explore the mediating role of immersion. METHODS A total of 22 children aged 8 to 12 years were randomly assigned to the NV or NNV condition. They were instructed to play an AVG (on Xbox Kinect) for as long as they wanted. We used accelerometers to estimate the time spent (in minutes) in MVPA. Heart rate (HR) and rate of perceived exertion (RPE) were measured before, during, and after the AVG play session. The participants then reported their experience of narrative immersion via a questionnaire. RESULTS The NV group had significantly higher narrative immersion (mean 3.50, SD 0.55 vs mean 2.91, SD 0.59; P=.03) and MVPA (mean 19.46, SD 13.31 vs mean 7.85, SD 5.83; P=.02) than the NNV group. Narrative immersion was positively correlated with MVPA (r=0.52; P=.01) and average HR during AVG (r=0.43; P=.05). Mediation analysis indicated that narrative immersion mediated the effect of NV (NV vs NNV) on MVPA (direct effect: beta=7.51; P=.01). The indirect effect was that NV was positively correlated with the mediator variable narrative immersion (beta=.59; P=.03), which was itself marginally associated with MVPA (beta=6.95; P=.09); when narrative immersion was included in the model, the regression coefficient was attenuated. CONCLUSIONS AVG with added narratives elicits more narrative immersion, resulting in more minutes in MVPA. Narrative immersion served as a mediator between NV and MVPA via its elicitation of an elevated HR without increasing RPE. The inclusion of immersive narratives in AVG could be helpful for inducing MVPA, to enhance AVG engagement without additional exertion.
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Affiliation(s)
- Caio Victor Sousa
- College of Arts, Media, and Design, Bouvé College of Health Sciences, Health Technology Lab, Northeastern University, Boston, MA, United States
| | - Austin Fernandez
- College of Arts, Media, and Design, Bouvé College of Health Sciences, Health Technology Lab, Northeastern University, Boston, MA, United States
| | - Jungyun Hwang
- Stanford University Medical Center, Department of Medicine, Palo Alto, CA, United States
| | - Amy Shirong Lu
- College of Arts, Media, and Design, Bouvé College of Health Sciences, Health Technology Lab, Northeastern University, Boston, MA, United States
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Sharifzadeh N, Kharrazi H, Nazari E, Tabesh H, Edalati Khodabandeh M, Heidari S, Tara M. Health Education Serious Games Targeting Health Care Providers, Patients, and Public Health Users: Scoping Review. JMIR Serious Games 2020; 8:e13459. [PMID: 32134391 PMCID: PMC7082739 DOI: 10.2196/13459] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 09/07/2019] [Accepted: 12/12/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Serious educational games have shown effectiveness in improving various health outcomes. Previous reviews of health education games have focused on specific diseases, certain medical subjects, fixed target groups, or limited outcomes of interest. Given the recent surge in health game studies, a scoping review of health education games is needed to provide an updated overview of various aspects of such serious games. OBJECTIVE This study aimed to conduct a scoping review of the design and evaluation of serious educational games for health targeting health care providers, patients, and public (health) users. METHODS We identified 2313 studies using a unique combination of keywords in the PubMed and ScienceDirect databases. A total of 161 studies were included in this review after removing duplicates (n=55) and excluding studies not meeting our inclusion criteria (1917 based on title and abstract and 180 after reviewing the full text). The results were stratified based on games targeting health care providers, patients, and public users. RESULTS Most health education games were developed and evaluated in America (82/161, 50.9%) and Europe (64/161, 39.8%), with a considerable number of studies published after 2012. We discovered 58.4% (94/161) of studies aiming to improve knowledge learning and 41.6% (67/161) to enhance skill development. The studies targeted various categories of end users: health care providers (42/161, 26.1%), patients (38/161, 23.6%), public users (75/161, 46.6%), and a mix of users (6/161, 3.7%). Among games targeting patients, only 13% (6/44) targeted a specific disease, whereas a growing majority targeted lifestyle behaviors, social interactions, cognition, and generic health issues (eg, safety and nutrition). Among 101 studies reporting gameplay specifications, the most common gameplay duration was 30 to 45 min. Of the 61 studies reporting game repetition, only 14% (9/61) of the games allowed the users to play the game with unlimited repetitions. From 32 studies that measured follow-up duration after the game intervention, only 1 study reported a 2-year postintervention follow-up. More than 57.7% (93/161) of the games did not have a multidisciplinary team to design, develop, or assess the game. CONCLUSIONS Serious games are increasingly used for health education targeting a variety of end users. This study offers an updated scoping review of the studies assessing the value of serious games in improving health education. The results showed a promising trend in diversifying the application of health education games that go beyond a specific medical condition. However, our findings indicate the need for health education game development and adoption in developing countries and the need to focus on multidisciplinary teamwork in designing effective health education games. Furthermore, future health games should expand the duration and repetition of games and increase the length of the follow-up assessments to provide evidence on long-term effectiveness.
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Affiliation(s)
- Nahid Sharifzadeh
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hadi Kharrazi
- Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, MD, United States
| | - Elham Nazari
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamed Tabesh
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Edalati Khodabandeh
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Somayeh Heidari
- Department of Medical Informatics, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahmood Tara
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Schwarz AF, Huertas-Delgado FJ, Cardon G, DeSmet A. Design Features Associated with User Engagement in Digital Games for Healthy Lifestyle Promotion in Youth: A Systematic Review of Qualitative and Quantitative Studies. Games Health J 2020; 9:150-163. [PMID: 31923363 DOI: 10.1089/g4h.2019.0058] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
User engagement in digital (serious) games may be important to increase their effectiveness. Insights into how to create engaging games for healthy lifestyle promotion are needed, as despite their potential, not all digital (serious) games are highly engaging. This study systematically reviewed game features that were associated with higher user engagement among youth. A systematic search was conducted in PubMed, Web of Science, CINAHL, and PsycARTICLES databases. Qualitative and quantitative studies were included, if they documented game features associated with youth engagement. Coding of game features was performed using the mechanics-dynamics-aesthetics (MDA) framework. A total of 60 studies met the inclusion criteria and were included in the registered systematic review (No. CRD42018099487). Results showed that various game features were associated with user engagement in digital (serious) games: an attractive storyline, adaptable to gender and age, including diverse (antagonist) characters the user may identify with, high-end realistic graphics, well-defined instructions, which can be skipped, in combination with clear feedback and a balance of educational and fun content. This review underpinned the relevance of investigating engaging game features specifically for youth, as deviations were found with characteristics that are engaging for other populations.
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Affiliation(s)
- Ayla F Schwarz
- Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium
| | - Francisco J Huertas-Delgado
- Department of Didactic of Musical, Plastical and Body Expression, La Inmaculada Teacher Training Centre, University of Granada, Granada, Spain
| | - Greet Cardon
- Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium
| | - Ann DeSmet
- Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium.,Research Foundation Flanders, Brussels, Belgium
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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.
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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
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Baranowski T, Lyons EJ. Scoping Review of Pokémon Go: Comprehensive Assessment of Augmented Reality for Physical Activity Change. Games Health J 2019; 9:71-84. [PMID: 31386564 DOI: 10.1089/g4h.2019.0034] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Pokémon Go™ (PG) is a mobile videogame that requires real-world walking to "catch" augmented reality (AR) virtual creatures. Media attention speculated that extensive physical activity (PA) could result from PG play, which could have public health benefit. Little is known about contextual factors related to PG play and how they may impact play initiation or duration. A systematic search of articles reporting the words PG was conducted with PubMed and Google Scholar. To understand the many possible influences on and outcomes of PG play, a scoping review was conducted by employing a conceptual model to organize the literature. Although large numbers of people started playing PG, these were a relatively small proportion of the relevant populations, but PG may have activated some of those most in need of PA. Diverse factors predicted who initiated PG play, but they tended to emphasize anticipated fun, escapism, nostalgia, social ties, and desire for PA. Environmental factors (e.g., unavailable GPS signals, trespassing laws) limited PG play for some. Diverse factors predicted duration of gameplay, but fun appeared to be prominent. The level of increases in PA from PG among youth and young adults appeared to be small or undetected, and of a relatively short duration (<2 months). Among older adults, however, there were modest increases in PA for up to 7 months post-release. This intensity and duration of increased PA appears to be inadequate to stem the epidemic of obesity but may have mental and social health benefits. Although many adverse outcomes from playing PG were reported, these appear to be low incidence, which should primarily influence PG players to knowingly exercise caution. Many research issues were identified to specify who might play AR games and effective strategies to enhance game design to increase PA.
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Affiliation(s)
- Tom Baranowski
- Department of Pediatrics, USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, Texas
| | - Elizabeth J Lyons
- The University of Texas Medical Branch, Institute for Translational Sciences, Galveston, Texas
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28
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Baranowski T, Ryan C, Hoyos-Cespedes A, Lu AS. Nutrition Education and Dietary Behavior Change Games: A Scoping Review. Games Health J 2019; 8:153-176. [PMID: 30339086 PMCID: PMC6909754 DOI: 10.1089/g4h.2018.0070] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Games provide an attractive venue for engaging participants and increasing nutrition-related knowledge and dietary behavior change, but no review has appeared devoted to this literature. A scoping review of nutrition education and dietary behavior change videogames or interactive games was conducted. A systematic search was made of PubMed, Agricola, and Google Scholar. Information was abstracted from 22 publications. To be included, the publication had to include a videogame or interactive experience involving games (a videogame alone, minigames inserted into a larger multimedia experience, or game as part of a human-delivered intervention); game's design objective was to influence dietary behavior, a psychosocial determinant of a dietary behavior, or nutrition knowledge (hereinafter referred to as diet-related); must have been reported in English and must have appeared in a professional publication, including some report of outcomes or results (thereby passing some peer review). This review was restricted to the diet-related information in the selected games. Diversity in targeted dietary knowledge and intake behaviors, targeted populations/audiences, game mechanics, behavioral theories, research designs, and findings was revealed. The diversity and quality of the research in general was poor, precluding a meta-analysis or systematic review. All but one of the studies reported some positive outcome from playing the game(s). One reported that a web-based education program resulted in more change than the game-based intervention. Studies of games may have been missed; a number of dietary/nutrition games are known for which no evaluation is known; and the data presented on the games and research were limited and inconsistent. Conclusions and Implications: A firmer research base is needed to establish the efficacy and effectiveness of nutrition education and dietary behavior change games.
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Affiliation(s)
- Tom Baranowski
- Department of Pediatrics, USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, Texas
| | - Courtney Ryan
- Department of Pediatrics, USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, Texas
| | | | - Amy Shirong Lu
- Health Technology Lab, Department of Communication Studies, College of Arts, Media & Design, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
- Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
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Kee T, Weiyan C, Blasiak A, Wang P, Chong JK, Chen J, Yeo BTT, Ho D, Asplund CL. Harnessing CURATE.AI as a Digital Therapeutics Platform by Identifying N‐of‐1 Learning Trajectory Profiles. ADVANCED THERAPEUTICS 2019. [DOI: 10.1002/adtp.201900023] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Theodore Kee
- Department of Biomedical EngineeringNational University of Singapore Singapore 117583
| | - Chee Weiyan
- The N.1 Institute for Health (N.1)National University of Singapore Singapore 117456
| | - Agata Blasiak
- Department of Biomedical EngineeringNational University of Singapore Singapore 117583
| | - Peter Wang
- The N.1 Institute for Health (N.1)National University of Singapore Singapore 117456
| | - Jordan K. Chong
- Department of Biomedical EngineeringNational University of Singapore Singapore 117583
| | - Jonna Chen
- The N.1 Institute for Health (N.1)National University of Singapore Singapore 117456
| | - B. T. Thomas Yeo
- The N.1 Institute for Health (N.1)National University of Singapore Singapore 117456
- Clinical Imaging Research CentreYong Loo Lin School of MedicineNational University of Singapore Singapore 117599
- Centre for Cognitive NeuroscienceDuke‐NUS Medical SchoolNational University of Singapore Singapore 169857
- Institute for Application of Learning Science and Educational TechnologyNational University of Singapore Singapore 119077
- Athinoula A. Martinos Center for Biomedical ImagingMassachusetts General HospitalHarvard Medical School 149 13th St Charlestown MA 02129 USA
| | - Dean Ho
- The N.1 Institute for Health (N.1)National University of Singapore Singapore 117456
- Department of Biomedical EngineeringNational University of Singapore Singapore 117583
- Department of PharmacologyYong Loo Lin School of MedicineBioengineering Institute for Global Health Research and TechnologyNational University of Singapore Singapore 117600
| | - Christopher L. Asplund
- The N.1 Institute for Health (N.1)National University of Singapore Singapore 117456
- Clinical Imaging Research CentreYong Loo Lin School of MedicineNational University of Singapore Singapore 117599
- Centre for Cognitive NeuroscienceDuke‐NUS Medical SchoolNational University of Singapore Singapore 169857
- Institute for Application of Learning Science and Educational TechnologyNational University of Singapore Singapore 119077
- Division of Social SciencesYale‐NUS CollegeNational University of Singapore Singapore 138533
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Holzmann SL, Dischl F, Schäfer H, Groh G, Hauner H, Holzapfel C. Digital Gaming for Nutritional Education: A Survey on Preferences, Motives, and Needs of Children and Adolescents. JMIR Form Res 2019; 3:e10284. [PMID: 30758290 PMCID: PMC6391648 DOI: 10.2196/10284] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 10/04/2018] [Accepted: 11/25/2018] [Indexed: 12/19/2022] Open
Abstract
Background Use of novel information and communication technologies are frequently discussed as promising tools to prevent and treat overweight and obesity in children and adolescents. Objective This survey aims to describe the preferences, motives, and needs of children and adolescents regarding nutrition and digital games. Methods We conducted a survey in 6 secondary schools in the southern region of Germany using a 43-item questionnaire. Questions referred to preferences, motives, and needs of children and adolescents regarding nutrition and digital games. In addition, knowledge regarding nutrition was assessed with 4 questions. We collected self-reported sociodemographic and anthropometric data. Descriptive statistical analyses were performed using SPSS. Results In total, 293 children and adolescents participated in the study, with ages 12-18 years (137 girls, 46.8%), weight 30.0-120.0 (mean 60.2 [SD 13.2]) kg, and height 1.4-2.0 (mean 1.7 [SD 0.1]) m. A total of 5.5% (16/290) correctly answered the 4 questions regarding nutrition knowledge. Study participants acquired digital nutritional information primarily from the internet (166/291, 57.0%) and television (97/291, 33.3%), while school education (161/291, 55.3%) and parents or other adults (209/291, 71.8%) were the most relevant nondigital information sources. Most participants (242/283, 85.5%) reported that they regularly play digital games. More than half (144/236, 61.0%) stated that they play digital games on a daily basis on their smartphones or tablets, and almost 70% (151/282, 66.5%) reported playing digital games for ≤30 minutes without any interruption. One-half of respondents (144/280, 51.4%) also stated that they were interested in receiving information about nutrition while playing digital games. Conclusions This survey suggests that nutrition knowledge in children and adolescents might be deficient. Most children and adolescents play digital games and express interest in acquiring nutritional information during digital gameplay. A digital game with a focus on sound nutrition could be a potential educational tool for imparting nutrition knowledge and promoting healthier nutrition behaviors in children and adolescents.
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Affiliation(s)
- Sophie Laura Holzmann
- Institute for Nutritional Medicine, Else Kroener-Fresenius-Center for Nutritional Medicine, University Hospital "Klinikum rechts der Isar", Technical University of Munich, Munich, Germany
| | - Felicitas Dischl
- Institute for Nutritional Medicine, Else Kroener-Fresenius-Center for Nutritional Medicine, University Hospital "Klinikum rechts der Isar", Technical University of Munich, Munich, Germany
| | - Hanna Schäfer
- Research Group Social Computing, Department of Informatics, Technical University of Munich, Garching, Germany
| | - Georg Groh
- Research Group Social Computing, Department of Informatics, Technical University of Munich, Garching, Germany
| | - Hans Hauner
- Institute for Nutritional Medicine, Else Kroener-Fresenius-Center for Nutritional Medicine, University Hospital "Klinikum rechts der Isar", Technical University of Munich, Munich, Germany.,Nutritional Medicine Unit, Institute for Food and Health, Technical University of Munich, Freising, Germany
| | - Christina Holzapfel
- Institute for Nutritional Medicine, Else Kroener-Fresenius-Center for Nutritional Medicine, University Hospital "Klinikum rechts der Isar", Technical University of Munich, Munich, Germany
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Precision gaming for health: Computer games as digital medicine. Methods 2018; 151:28-33. [PMID: 30273711 DOI: 10.1016/j.ymeth.2018.09.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 08/14/2018] [Accepted: 09/27/2018] [Indexed: 11/22/2022] Open
Abstract
Health based games have significant potential as therapeutic interventions due to the inherent mechanisms associated with social and individual game play and their capacity for sensor integration, data capture analysis and patient feedback. Moreover, they are low cost and they can be deployed at the point of care across an evolving digital ecosystem. However, a robust evidence base to support their wider adoption as a clinical intervention for chronic diseases is lacking and significant methodological barriers exist for health games developers creating efficacious 'digital medicines'. Game design is complex and it must utilise validated game mechanics balanced with a creative and engaging game design. The aim of this review is therefore to outline the fundamental steps of game development for health professionals and to critically appraise the methodology for assessing health games as medical interventions. This requires (1) The adoption of clearly defined global language for health games development based on a targeted function as therapeutic agents. (2) The development of multidisciplinary teams with a broad portfolio of development and clinical skill sets. (3) The creation of health game engines specifically built to facilitate clinical game development. (4) Robust trial design and assessment of translational impact: If games are to be prescribed, their efficacy and toxicity must be based on a rigorous assessment of their use within a real world clinical environment. Trials for precision health games have specific challenges around blinding, learning curves, bias and confounding that are particularly problematic. We propose the adoption of the IDEAL-GAMES framework for game development that systematically assess and validates games through open registries. In conclusion we propose a new framework for assessing the robustness and clinical efficacy of games for health as clinical interventions in the clinical environment.
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Spielerische Ansätze als innovative Kommunikationsstrategie der Gesundheitsförderung und Prävention. PRÄVENTION UND GESUNDHEITSFÖRDERUNG 2018. [DOI: 10.1007/s11553-018-0672-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Gesundheitsangebote für Kinder und Jugendliche im App-Format. PRÄVENTION UND GESUNDHEITSFÖRDERUNG 2018. [DOI: 10.1007/s11553-018-0665-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Bertozzi E, Bertozzi-Villa A, Kulkarni P, Sridhar A. Collecting family planning intentions and providing reproductive health information using a tablet-based video game in India. Gates Open Res 2018; 2:20. [PMID: 29984358 PMCID: PMC6030399 DOI: 10.12688/gatesopenres.12818.2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2018] [Indexed: 11/20/2022] Open
Abstract
Background: In response to a Grand Challenges in Global Health call for action to collect data about family planning intentions and increase the uptake of family planning methods in India, our team designed, developed, and piloted the
My Future Family video game in Karnataka Province. The game educates adolescents about human sexuality and reproduction while asking players when they would like to achieve five important family planning milestones. Participants were also asked to report who influences them the most when making family planning decisions. Methods: Focus groups were conducted and the resulting data used to design the game which was iteratively tested and then piloted in 11 schools in rural and urban areas of southern India. Data was collected throughout gameplay and cross-checked with paper questionnaires. Results: In August 2017, we successfully piloted the game with 382 adolescents and validated its efficacy both as an educational tool and as an innovative means of accurate data collection. Conclusion: It has historically been problematic to gather accurate data about adolescents in India on this culturally sensitive topic for a variety of reasons. These include difficulties obtaining consent, developing appropriate survey methods, and framing questions in language that young people can understand. Our game met these challenges by working within a single school system with approval from senior administration, delivering information via a game environment which freed players from societal constraints, and communicating information via images and audio in addition to text in both English and Kannada (the local language).
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Affiliation(s)
- Elena Bertozzi
- Department of Game Design & Development, Quinnipiac University, Hamden, CT, USA
| | | | - Praveen Kulkarni
- Department of Community Medicine, JSS Medical College, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India
| | - Aparna Sridhar
- Department of Obstetrics and Gynecology, David Greffen School of Medicine, Los Angeles, CA, USA
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Einführung in die Vergangenheit, Gegenwart und Zukunft von Serious Games (for Health). PRAVENTION UND GESUNDHEITSFORDERUNG 2018. [DOI: 10.1007/s11553-018-0667-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Should We Play Games Where Energy Is Concerned? Perceptions of Serious Gaming as a Technology to Motivate Energy Behaviour Change among Social Housing Residents. SUSTAINABILITY 2018. [DOI: 10.3390/su10061729] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Bertozzi E, Bertozzi-Villa A, Kulkarni P, Sridhar A. Collecting family planning intentions and providing reproductive health information using a tablet-based video game in India. Gates Open Res 2018; 2:20. [DOI: 10.12688/gatesopenres.12818.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2018] [Indexed: 11/20/2022] Open
Abstract
Background: In response to a Grand Challenges in Global Health call for action to collect data about family planning intentions and increase the uptake of family planning methods in India, our team designed, developed, and piloted the My Future Family video game in Karnataka Province. The game educates adolescents about human sexuality and reproduction while asking players when they would like to achieve five important family planning milestones. Participants were also asked to report who influences them the most when making family planning decisions. Methods: Focus groups were conducted and the resulting data used to design the game which was iteratively tested and then piloted in 11 schools in rural and urban areas of southern India. Data was collected throughout gameplay and cross-checked with paper questionnaires. Results: In August 2018, we successfully piloted the game with 382 adolescents and validated its efficacy both as an educational tool and as an innovative means of accurate data collection. Conclusion: It has historically been problematic to gather accurate data about adolescents in India on this culturally sensitive topic for a variety of reasons. These include difficulties obtaining consent, developing appropriate survey methods, and framing questions in language that young people can understand. Our game met these challenges by working within a single school system with approval from senior administration, delivering information via a game environment, which freed players from societal constraints, and communicating information via images and audio in addition to text in both English and Kannada (the local language).
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