Health Education Serious Games Targeting Health Care Providers, Patients, and Public Health Users: Scoping Review

Perceptions of game-based education among parents during the perinatal period: A mixed studies review

BACKGROUND

Experiential education, particularly through game-based approaches, has gained recognition for effectively addressing the myriad challenges faced by expectant parents.

AIM

To consolidate and synthesize the available evidence regarding expectant parents' experiences of game-based perinatal education.

DESIGN

A mixed studies review.

DATA SOURCES

Six electronic databases were searched from their inception until March 2024: PubMed, Embase, CINAHL, Web of Science, Scopus, ProQuest Dissertations and Theses Global.

METHODS

This review observed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was guided by Pluye and Hong's (2014) framework for mixed studies review. Quality appraisal of included studies was conducted using the Mixed Methods Appraisal Tool. A convergent qualitative synthesis design for mixed studies review was adopted to analyse all findings and thematic analysis was conducted.

FINDINGS

Three themes and 10 subthemes were generated from the eight included studies. The main themes were: (1) Exploring novel frontiers to deliver perinatal education, (2) Empowerment through play: Unveiling key insights and (3) Insights and recommendations.

CONCLUSION

The findings suggest that game-based education holds promise as a valuable tool for equipping expectant parents with the necessary knowledge and skills in an engaging and immersive manner to navigate the challenging perinatal period.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

The findings suggest that game-based education holds promise as a valuable tool for equipping expectant parents with the necessary knowledge and skills to navigate the challenging perinatal period. Nurses should consider incorporating or developing a game-based curriculum to supplement current educational classes to encourage parental participation and enhance learning for perinatal education.

REPORTING METHOD

This study adhered to the PRISMA reporting guidelines.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution.

TRIAL AND PROTOCOL REGISTRATION

A protocol was submitted to PROSPERO (CRD42023447527).

Playing for understanding: The impact of interactive gaming on young adults' sexual health education

OBJECTIVES

This study examines the impact of a "choose your own adventure" (CYOA) game on improving understanding and facilitating discussions about dating, sex, and sexual health among immigrant and refugee youth who often face cultural and language barriers.

STUDY DESIGN

A qualitative exploratory design was used to capture participants' experiences with the game.

METHODS

Thirty-two immigrant and refugee youth aged 18-25 participated in semi-structured interviews. Inductive thematic analysis was conducted to explore the perceived effectiveness of the CYOA game, which was accessible via smartphones and desktop devices.

RESULTS

Participants described the CYOA game as an accessible and engaging way to explore sensitive topics, providing a discreet and safe environment for learning and discussion. Cultural and religious backgrounds influenced comfort levels, and culturally sensitive content and non-judgmental delivery were particularly valued. Participants reported that while school-based sexual health education was often insufficient, community programs provided more relevant support.

CONCLUSIONS

CYOA games are perceived to be effective educational tools for sexual health, especially when they incorporate culturally appropriate content. These games foster open discussions and understanding among immigrant and refugee youths, highlighting the need for culturally relevant resources to support traditional approaches to promoting sexual health.

Insights on Improving Health Insurance Literacy in Diabetes

CONTEXT

Many adults with diabetes cannot afford medications or health care and have low health insurance literacy, resulting in psychological distress and barriers to optimal self-management.

OBJECTIVE

This mini-review aimed to explore the effectiveness of health-insurance literacy interventions and provide recommendations for diabetes practice.

METHODS

We conducted a thorough search of relevant PubMed and Scopus studies from 2014 to 2024. Our inclusion criteria were interventions or pilot intervention studies using the search terms "health insurance" OR "health insurance literacy" OR "population (oncology, young adults/college/university students, and adults)." We then meticulously analyzed the quality of these studies, and assessments were conducted in Excel. We synthesized the evidence on interventions used to support health-insurance literacy across chronic health conditions and the general population, and their applications to diabetes care. Our findings showed effective interventions address a population's specific learning needs and literacy level. Multiple/diverse methods were used, including web-based decision aids, virtual sessions, hands-on support from navigators, Serious Games, educational workshops, and online microvideo Toolkits. Critical gaps included defining and measuring health-care literacy.

CONCLUSION

Solutions for health-insurance education include strategies to incorporate education into academic curricula, diabetes transition programs, community health fairs, and employing community health workers within health-care systems. Although there is a validated health insurance literacy measure, consistent use of this measure across future programs can further the critically needed science in this field.

Evaluating the Efficacy of a Serious Game to Deliver Health Education About Invasive Meningococcal Disease: Clustered Randomized Controlled Equivalence Trial

BACKGROUND

Invasive meningococcal disease (IMD) is a serious, vaccine-preventable infectious disease that can be life-threatening. Teaching adolescents about the early detection and prevention of IMD can be challenging in a school environment, with educators reporting they lack confidence or expertise to cover this in the classroom environment. Professional guest educators are an alternative to cover specialist topics such as IMD; however, time and resourcing constraints can mean that these educators are not always available. Serious games may be an alternative to face-to-face education, where complex health information may be delivered via self-directed gameplay.

OBJECTIVE

This study aims to develop a serious game that can replace a face-to-face educator in a classroom setting to educate adolescents aged 12 years to 15 years. This study evaluates the efficacy of the Meningococcal Immunisation Awareness, Prevention and Protection app (MIApp), a serious game designed to replicate the information provided in a 30-minute face-to-face presentation provided by a trained educator.

METHODS

This clustered, randomized controlled equivalence trial involved students (Years 7-10) from 6 secondary schools across metropolitan Western Australia who completed pre- and postintervention questionnaires with a follow-up at 3 months postintervention to measure the primary outcome of IMD knowledge acquisition following this self-guided intervention. The findings were compared with changes in an active control (comparison) group who received an in-class educational presentation about IMD transmission and protection. A questionnaire was developed to assess 9 key areas of knowledge. Median scores for knowledge pre- and postintervention were collected from a self-administered assessment of this questionnaire and, at 3 months postintervention, were compared between groups. A knowledge score of +/-2/16 was determined a priori to meet the criteria for equivalence. Participants who used MIApp were also asked a series of questions to assess the enjoyment of and engagement with the game.

RESULTS

Of the 788 participating students, the median postintervention correct score in both the MIApp and control cohorts was 14/16 (87.5% correct responses), compared with the median pre-intervention correct score of 6/16 (37.5% correct responses), representing a significant (P<.001) increase in IMD knowledge in both groups. Improvements were retained in both groups 3 months after the initial intervention (median correct score: 11/16 in the intervention group; 12/16 in the control group; P=.86), demonstrating the efficacy of MIApp to deliver health education about IMD transmission and protection, although response rates in the follow-up cohort were low (255/788, 32.4%).

CONCLUSIONS

MIApp met the predetermined threshold for equivalence, demonstrating similar improvements in knowledge posttrial and at the 3-month follow-up. Participating adolescents considered the MIApp game more enjoyable than a presentation, with equivalent improvements in knowledge. Serious games could represent a constructive tool to help teachers impart specialized health education.

Pervasive Games for Sexual Health Promotion: Scoping Literature Review

BACKGROUND

Serious games play a fundamental role in promoting safe sexual behaviors. This medium has great potential for promoting healthy behaviors that prevent potential risk factors, such as sexually transmitted infections, and promote adherence to sexual health treatments, such as antiretroviral therapy. The ubiquity of mobile devices enhances access to such tools, increasing the effectiveness of video games as agents of change.

OBJECTIVE

In this scoping review, we aimed to (1) identify the extent to which pervasive games have been used in the field of sexual health, (2) determine the theories used in the design and evaluation of pervasive games for sexual health, (3) identify the methods used to evaluate pervasive games for sexual health, and (4) explore the reported benefits of using pervasive games for sexual health.

METHODS

Following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) methodology, we conducted a comprehensive literature search in the Web of Science, Scopus, IEEE Xplore, and ACM databases for articles published between January 1, 2000, and August 4, 2024. Included articles were published in English between 2000 and 2024 and involved the design, implementation, or evaluation of a ubiquitous video game focused on promoting safe sexual behaviors, with qualitative and/or quantitative results based on theory-based techniques and ubiquitous technologies. Review articles, conference papers, or books without available data or quantitative or qualitative results were excluded.

RESULTS

We screened 521 of 612 articles (85.1%) after removing duplicates. After the title and abstract review, 51 (9.8%) articles were assessed for eligibility, and 30 (5.8%) articles meeting the criteria were studied and evaluated in depth. The results suggested that the use of pervasive video games has a positive impact on promoting safe sexual behaviors. This is enhanced by the effectiveness of theory-based techniques and the use of mobile technologies as developmental factors that drive the gaming experience. The results indicated that this domain is a growing field that should not be ignored.

CONCLUSIONS

The literature showed that pervasive video games have been effective in promoting safe sexual behaviors. Substantial growth has been seen in scientific community interest in researching this domain; nevertheless, there is still much to work on. In this context, we advocate for the standardization of design, implementation, and experimentation as essential phases in creating video game experiences. These 3 fundamental aspects are critical in the development of video game-based studies to ensure the reproducibility of experiments.

Gamified Health Promotion in Schools: The Integration of Neuropsychological Aspects and CBT-A Systematic Review

Background and Objectives: This systematic review examines the integration of gamified health promotion strategies in school settings, with a focus on their potential to positively influence health behaviors and promote well-being among adolescents. This study explores the incorporation of cognitive behavioral therapy (CBT), artificial intelligence, and neuropsychological principles in gamified interventions, aiming to enhance engagement and effectiveness. Materials and Methods: A narrative synthesis of 56 studies, following PRISMA guidelines, underscores the significant impact of these gamified interventions on mental health outcomes, emphasizing reductions in anxiety, depression, and burnout while improving coping skills and lifestyle habits. The focus of key areas in mental health outcomes, emotional regulation, cognitive flexibility, and adherence mechanisms is explored through quantitative and qualitative syntheses to underscore intervention effectiveness and design principles. Results: This review highlights the high-quality evidence supporting the use of gamification in educational settings and calls for further research to optimize design elements and address implementation barriers. The findings propose that well-designed gamified health interventions can effectively engage students, promote healthy behaviors, and improve mental well-being while acknowledging the need for further studies to explore underlying mechanisms and long-term effects. Conclusions: Gamified health interventions that embed CBT and neuropsychological principles are promising for promoting the mental well-being of schoolchildren. Although the evidence indicates that they are effective in improving psychological and behavioral outcomes, further research is needed to optimize design features and overcome implementation challenges to ensure wider and more sustainable application.

Patient card games in palliative care: integrative review

BACKGROUND

In the context of palliative care, a new approach has been documented that allows for sensitive end-of-life conversations to be established through a game of cards.

OBJECTIVE

This study aimed to identify the use of card games with patients in palliative care, assess self-reported satisfaction and synthesise findings on the effectiveness of its application.

DESIGN

We performed an integrative review study. The studies were collected from five databases, with no time limit until February 2021: Medical Literature Analysis and Retrieval System Online, Cumulative Index to Nursing and Allied Health Literature, Psychology and Behavioral Sciences Collection, SCOPUS and Scientific Electronic Library Online. The inclusion criteria were studies describing the use of card games in adult patients undergoing palliative care, in which the authors performed some type of evaluation. The methodological evaluation of the studies was carried out using the different standardised assessment tools from the Joanna Brigg's Institute.

RESULTS

Of the 685 articles identified, 9 met the inclusion criteria. Regarding methodological aspects, 4 studies were quantitative, 4 mixed-method methodologies, and 1 was qualitative. Card games have been in use for the last decade. The use of card games not only allows for participation in the game without any inhibitions and with a high degree of satisfaction, but also allows for the discussion of sensitive topics related to the end of life, motivating participants to engage in advanced care planning behaviours.

CONCLUSION

Our findings suggest that using a card game to facilitate conversations with patients in palliative care is a useful and effective approach to discussing uncomfortable topics of death, dying and end-of-life care.

Serious Game for the Nursing Assessment of Home-Dwelling Older Adults: Development and Validation Study

BACKGROUND

The use of serious games (SGs) in nursing education is increasing, with the COVID-19 pandemic significantly accelerating their development. A key feature of SGs is their flexibility, allowing students to train at any place and time as needed. Recently, there has been a shift from developing disease-specific SGs to games focused on broader health issues. However, there has been a lack of proposals to enhance nursing interventions in home and frail care settings. The REACtion project developed a SG to improve students' understanding and clinical reasoning in caring for home-dwelling older adults.

OBJECTIVE

This study aims to describe the development of "REACtion Game" (RG) and explore its validity as an educational tool. A multidisciplinary team created a SG that simulates the assessment process of older adults in home settings by nurses. It features web-based scenarios, clickable objects, and a menu with tools, and medical records to enhance nursing students' knowledge and clinical reasoning skills.

METHODS

A prospective, observational study was conducted using the Dutch Society for Simulation in Healthcare's framework to validate the game. Further, 5 experts in home health care nursing evaluated content validity, while 30 students assessed construct validity, face validity, concurrent validity (by comparing game scores with those from the Nursing Clinical Reasoning Scale), game quality, and usability. Data were collected through self-administered web-based questionnaires and the debriefings of each match played. The students were enrolled in 2 postgraduate nursing programs: a master of science in nursing degree and a first-level continuing education in family and community nursing.

RESULTS

Experts rated the content validity highly after revisions (universal agreement calculation method of scale-level content validity index=0.97). The sample consisted of 30 students, predominantly women (n=20, 67%) and aged younger than 45 years (n=23, 77%) with no prior experience in SG. Almost all students had a positive impression of RG as an attractive and useful method for learning new knowledge. Participants found the cases, scenarios, and dialogues realistic (face validity) and of high quality, though usability aspects such as instructions clarity and intelligibility of game progression were less favored. Construct validity showed general agreement on the game's educational value, with family and community nursing students reporting more consistent alignment with educational goals. Overall, RG scores correlated positively with time spent playing but showed limited correlation with Nursing Clinical Reasoning Scale scores.

CONCLUSIONS

This study developed and validated a nursing education game, especially valuable as simulation is underused in some curricula. Created during the pandemic, it offered a digital learning environment. Although the game shows potential, further testing is needed for usability, concurrent validity, and functional improvements. Future research should involve larger samples to fully validate the game and assess its impact on academic achievement.

Supporting contraceptive self-care and reproductive empowerment with a digital health game in Barbados: Development and Pre-implementation study for What's My Method?

Effective contraceptive education is essential to reducing unwanted pregnancy, increasing uptake of modern contraceptive methods, and thoughtfully planning desired births. New World Health Organization (WHO) and family planning organization guidelines recommend situating contraceptive education and counseling within a broader context of self-care that emphasizes individual agency and reproductive empowerment. Digital health interventions, and games for health specifically, have been validated as effective and scalable tools for self-guided and interactive health education, especially among younger tech-savvy individuals. Barbados currently supplements provider-based contraceptive counseling with analog materials (pamphlets and posters) and informational videos that play on a screen in the waiting room. As part of an implementation framework, this study seeks to conduct a formative evaluation of the What's My Method? (WMM) game intervention as a tool to support contraceptive counseling and increase reproductive empowerment among childbearing persons in Barbados. We test-deployed the WMM game in Bridgetown, Barbados, conducting playtests and unstructured discussions with prototypes of the WMM game among three groups of stakeholders (youth contraception ambassadors: n=8; healthcare providers: n=7; and nursing students: n=27) to determine acceptability of the intervention, efficacy of the game as a learning tool, and willingness to adopt the tool in their healthcare context. Feedback on acceptability of the game was largely positive. Detailed constructive comments informed modifications and improvements to the game. The questionnaire used to assess contraceptive knowledge gain did not prove effective. Results indicate that the WMM game is well-received and accepted by the healthcare professionals who would be deploying it. This pilot testing has informed the design of the modified WMM for a randomized controlled trial (RCT) to test the deployment of the game in a healthcare setting.

Introduction of a learning pathway combining passive and interactive formats in gerodontology: A pilot study

BACKGROUND

During the 2021-2022 academic year, an integrated curriculum in gerodontology, including interactive teaching activities, has been proposed from the second to the fifth year of initial training. This pilot study aimed to evaluate the educational impact of interactive online mandatory activities including three quizzes and a serious game (SG) offered to fourth-year students in addition to passive courses in gerodontology.

MATERIALS AND METHODS

Students' participation in the quizzes and SG and their subsequent satisfaction were evaluated. Students' performance for managing a dental visit with older patients were also assessed by using two tests proposed before and after the completion of the third quiz and the SG. Scores obtained to these tests were then submitted to a paired t-test. Significance levels were set at p < 0.05.

RESULTS

Student participation in the three quizzes and SG remained high throughout the semester. The level of satisfaction with the course was high (respectively 26.7% very satisfactory and 65.5% satisfactory). Finally, mean ± SD scores of performances were 65.6 ± 9.2 before and 69.5 ± 9.8 after the completion of the third quiz and the SG (p = 0.0002, t-test, df = 163).

CONCLUSION

The frequency of use and the scores obtained in interactive activities suggest that students were involved in their gerodontology training during the semester. The learning outcomes of fourth-year students were improved after the interactive activities. The introduction of a training pathway based on interactive activities could facilitate the acquisition of knowledge and skills by undergraduates in gerodontology.

The impact of an online gamified virtual tour on cognitive enhancement in dental practice management

Dental practice management is usually a mandatory course for both undergraduate and postgraduate programs. However, learners and educators may encounter challenges in gaining experiences in real-life dental practice. The concept of a gamified virtual tour could have potential to improve dental practice management skills. A quasi-experimental study was conducted to evaluate the educational impact of a gamified virtual dental clinic (GVDC) on dental practice management skills among dental undergraduates (UG) and postgraduates (PG). All participants were assigned to complete the GVDC. Pre- and post-knowledge assessments were administered to evaluate knowledge acquisition. A self-administered questionnaire was distributed to investigate user perceptions toward the use of GVDC. There were 20 dental undergraduates and 20 orthodontic residents participating in UG and PG groups, respectively. Both groups demonstrated statistically significant increases in their assessment scores after completing the GVDC (P < 0.001). Although the pre-knowledge assessment score of the PG group was notably higher than that of the UG group (P = 0.041), there was no statistically significant difference in their post-knowledge assessment score (P = 0.491). Participants had positive perceptions of GVDC in terms of usefulness, ease of use, and enjoyment, with no statistically significant differences between the two groups (P > 0.05). Overall, the GVDC demonstrated positive educational impacts on acquiring knowledge and understanding of dental practice management, with participants expressing favorable perceptions of this immersive learning intervention.

Development and evaluation of an emergency department serious game for undergraduate medical students

BACKGROUND

Serious games are risk-free environments training various medical competencies, such as clinical reasoning, without endangering patients' safety. Furthermore, serious games provide a context for training situations with unpredictable outcomes. Training these competencies is particularly important for healthcare professionals in emergency medicine.

METHODS

Based on these considerations, we designed, implemented, and evaluated a serious game in form of an emergency department, containing the features of a virtual patient generator, a chatbot for medical history taking with self-formulated questions, artificially generated faces based on an artificial intelligence algorithm, and feedback for students. The development process was based on an already existing framework resulting in an iterative procedure between development and evaluation. The serious game was evaluated using the System Usability Scale and the User Experience Questionnaire.

RESULTS

The System Usability Scale provided a substantial result for the usability. In terms of the user experience, four scales yielded positive results, whereas two scales yielded neutral results.

CONCLUSION

The evaluation of both usability and user experience yielded overall positive results, while simultaneously identifying potential areas for improvement. Further studies will address the implementation of additional game design elements, and testing student learning outcome.

An Evidence-Based Serious Game App for Public Education on Antibiotic Use and Resistance: Randomized Controlled Trial

BACKGROUND

The misuse and overuse of antibiotics accelerate the development of antimicrobial resistance (AMR). Serious games, any form of games that serve a greater purpose other than entertainment, could augment public education above ongoing health promotion efforts. Hence, we developed an evidence-based educational serious game app-SteWARdS Antibiotic Defence-to educate players on good antibiotic use practices and AMR through a game quest comprising 3 minigames and interaction with the nonplayer characters.

OBJECTIVE

We aimed to evaluate the effectiveness of the SteWARdS Antibiotic Defence app in improving the knowledge of, attitude toward, and perceptions (KAP) of appropriate antibiotic use and AMR among the public in Singapore.

METHODS

We conducted a 2-arm parallel randomized controlled trial, recruiting visitors aged 18-65 years from 2 polyclinics in Singapore. Intervention group participants had to download the SteWARdS Antibiotic Defence app (available only in English and on the Android platform) on their smartphones and complete the quest in the app. Participants took half a day to 2 weeks to complete the quest. The control group received no intervention. Knowledge questions on antibiotic use and AMR (11 binary questions) were self-administered at baseline, immediately after the intervention, and 6-10 weeks post intervention, while attitudes and perception questions (14 three-point Likert-scale questions) were self-administered at baseline and 6-10 weeks post intervention. We also collected participants' feedback on app usage.

RESULTS

Participants (n=348; intervention: n=142, control: n=206) had a mean age of 36.9 years. Intervention group participants showed a statistically significant improvement in mean knowledge score (effect size: 0.58 [95% CI 0.28-0.87]) compared with controls after accounting for age, educational level, and exposure to advertisements on antibiotics and AMR. Intervention participants also showed a statistically significant improvement in mean attitude-perception scores (effect size: 0.98 (95% CI 0.44-1.52)) after adjusting for marital status and race. A majority of participants agreed that the "SteWARdS Antibiotic Defence" app improved their awareness on antibiotic use (135/142, 95.1%) and AMR (136/142, 95.8%). About 73.9% (105/142) of the participants agreed that the app is easy to use, 70.4% (100/142) agreed that the app was enjoyable, and 85.2% (121/142) would recommend the app to others.

CONCLUSIONS

Our educational serious game app improves participants' KAP on appropriate antibiotic use and AMR. Public education apps should be engaging, educational, easy to use, and have an attractive user interface. Future research should assess the effectiveness of interventions in facilitating long-term knowledge retention and long-lasting behavioral change.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05445414; https://clinicaltrials.gov/ct2/show/NCT05445414.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/45833.

Digital Serious Games to Promote Behavior Change in Children With Chronic Diseases: Scoping Review and Development of a Self-Management Learning Framework

BACKGROUND

Digital serious games (SGs) have rapidly become a promising strategy for entertainment-based health education; however, developing SGs for children with chronic diseases remains a challenge.

OBJECTIVE

In this study, we attempted to provide an updated scope of understanding of the development and evaluation of SG educational tools and develop a framework for SG education development to promote self-management activities and behavior change in children with chronic diseases.

METHODS

This study consists of a knowledge base and an analytical base. This study followed the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. To build the knowledge base, 5 stages of research were developed, including refining the review question (stage 1), searching for studies (stage 2), selecting relevant studies (stage 3), charting the information (stage 4), and collating the results (stage 5). Eligible studies that developed SG prototypes and evaluated SG education for children with chronic diseases were searched for in PubMed, Embase, Google Scholar, and peer-reviewed journals. In the analytical base, the context-mechanism-output approach and game taxonomy were used to analyze relevant behavioral theories and essential game elements. Game taxonomy included social features, presentation, narrative and identity, rewards and punishment, and manipulation and control. A total of 2 researchers selected the domains for the included behavioral theories and game elements. The intended SG framework was finalized by assembling SG fragments. Those SG fragments were appropriately reintegrated to visualize a new SG framework.

RESULTS

This scoping review summarized data from 16 randomized controlled trials that evaluated SG education for children with chronic diseases and 14 studies on SG frameworks. It showed that self-determination theory was the most commonly used behavioral theory (9/30, 30%). Game elements included feedback, visual and audio designs, characters, narratives, rewards, challenges, competitions, goals, levels, rules, and tasks. In total, 3 phases of a digital SG framework are proposed in this review: requirements (phase 1), design and development (phase 2), and evaluation (phase 3). A total of 6 steps are described: exploring SG requirements (step 1), identifying target users (step 2), designing an SG prototype (step 3), building the SG prototype (step 4), evaluating the SG prototype (step 5), and marketing and monitoring the use of the SG prototype (step 6). Safety recommendations to use digital SG-based education for children in the post-COVID-19 era were also made.

CONCLUSIONS

This review summarizes the fundamental behavioral theories and game elements of the available literature to establish a new theory-driven step-by-step framework. It can support game designers, clinicians, and educators in designing, developing, and evaluating digital, SG-based educational tools to increase self-management activities and promote behavior change in children with chronic diseases.

Effects of Electronic Serious Games on Older Adults With Alzheimer's Disease and Mild Cognitive Impairment: Systematic Review With Meta-Analysis of Randomized Controlled Trials

BACKGROUND

Serious games (SGs) are nonpharmacological interventions that are widely applied among older adults. To date, no evidence has been published regarding the effect of digital SGs on cognitive ability, daily behavioral capacity, or depression in older adults with Alzheimer's disease (AD) and mild cognitive impairment (MCI).

OBJECTIVE

This study aimed to assess the effect of SGs on older adults with AD and MCI by summarizing and pooling the results of previous studies.

METHODS

This meta-analysis examined the effectiveness of digital SGs in improving cognitive ability, enhancing daily behavioral capacity, and alleviating depression in older adults with AD and MCI. We searched the following databases up to December 31, 2023, to identify relevant high-quality randomized controlled trials (RCTs): PubMed, Embase, Web of Science, Scopus, and Cochrane Library. Stata 15.1 and Review Manager 5.3 were used to screen the 14 studies, extract data, code the data, and perform meta-analysis. Mean differences and standardized mean differences (SMDs) with 95% CIs were used to calculate continuous variables. The Cochrane risk-of-bias assessment tool was used to evaluate the risk of bias. Eligibility criteria were developed in accordance with the Population, Intervention, Comparison, Outcomes, and Study Design framework: (1) population (older adults with AD and MCI), (2) intervention (digital SG intervention), (3) comparison (digital SG intervention vs routine health care), (4) outcomes (cognitive ability, daily behavioral capacity, and depression), and (5) study or research design (RCT). Sensitivity analysis was performed, and a funnel plot was constructed.

RESULTS

From January 2017 to December 2023, we enrolled 714 individuals across 14 RCTs, with 374 (52.4%) in the severe game group using digital SGs and 340 (47.6%) in the control group using traditional methods. The results of our meta-analysis indicated that using digital SGs in older adults with AD and MCI is more effective than traditional training methods in several key areas. Specifically, digital SG therapy significantly increased cognitive ability, as found in the Mini-Mental State Examination (SMD 2.11, 95% CI 1.42-2.80; P<.001) and the Montreal Cognitive Assessment (SMD 2.75, 95% CI 1.98-3.51; P<.001), significantly increased daily behavioral capacity (SMD 0.53, 95% CI 0.06-0.99; P=.03), and significantly reduced depression (SMD -2.08, 95% CI -2.94 to -1.22; P<.001) in older adults with AD and MCI. No publication bias was detected based on the results of Begg and Egger tests.

CONCLUSIONS

Digital SGs offer a viable and effective nonpharmacological approach for older adults with AD and MCI, yielding better results compared to traditional formats. However, caution is warranted in interpreting these findings due to limited RCTs, small sample sizes, and low-quality meta-analyzed evidence.

TRIAL REGISTRATION

PROSPERO International Prospective Register of Systematic Reviews: CRDCRD42023486090; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=486090.

Online Game-Based Parental Groups: The Experiences of First-Time Expectant Parents

Although evidence exists on the use of gamification and serious games in many fields, game-based methods are a relatively new phenomenon in the family services sector. This study focused on the implementation of game-based online parental groups organized for first-time expectant parents and participants' experiences of playing together. In total, 26 Finnish first-time expectant parents participated in the study. Data were analyzed using thematic analysis. Three main themes describing the expectant parents' experiences were related to the game as a stimulator of discussion, the experience of gaming, and special features of online group discussion. It is concluded that playing online learning games with others can lower the threshold to participate and offer new possibilities for interactive parental education.

Impact of Serious Games on Body Composition, Physical Activity, and Dietary Change in Children and Adolescents: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Over the past four decades, obesity in children of all ages has increased worldwide, which has intensified the search for innovative intervention strategies. Serious games, a youth-friendly form of intervention designed with educational or behavioral goals, are emerging as a potential solution to this health challenge. To analyze the effectiveness of serious games in improving body composition, physical activity, and dietary change, we performed a systematic review and meta-analysis of randomized controlled trials (RCTs) from PubMed, Web of Science, EMBASE, and Scopus databases. Pooled standardized mean differences (SMD) were calculated for 20 studies (n = 2238 the intervention group; n = 1983 in the control group) using random-effect models. The intervention group demonstrated a slightly better, although non-significant, body composition score, with a pooled SMD of -0.26 (95% CI: -0.61 to 0.09). The pooled effect tends to be stronger with longer duration of intervention (-0.40 [95% CI: -0.96, 0.16] for >3 months vs. -0.02 [95% CI: -0.33, 0.30] for ≤3 months), although the difference was not statistically significant (p-difference = 0.24). As for the specific pathways leading to better weight control, improvements in dietary habits due to serious game interventions were not significant, while a direct positive effect of serious games on increasing physical activity was observed (pooled SMD = 0.61 [95% CI: 0.04 to 1.19]). While the impact of serious game interventions on body composition and dietary changes is limited, their effectiveness in increasing physical activity is notable. Serious games show potential as tools for overweight/obesity control among children and adolescents but may require longer intervention to sustain its effect.

Co-design and evaluation of a digital serious game to promote public awareness about pancreatic cancer

BACKGROUND

Pancreatic cancer, ranking seventh in global cancer-related deaths, poses a significant public health challenge with increasing incidence and mortality. Most cases are diagnosed at an advanced stage, resulting in low survival rates. Early diagnosis significantly impacts prognosis, making symptom awareness crucial. Symptoms are often subtle, leading to delayed help-seeking behaviour. Patients and their carers prioritise increased public awareness, indicating a need for innovative approaches to promote awareness of the disease.

METHODS

This study employed a quasi-experimental pre-test/post-test design to assess the relationship between a serious game and pancreatic cancer awareness. Members of the public (N = 727) were recruited internationally, via social media and with signposting by relevant organisations. Participants completed measures of symptom awareness and help-seeking intentions before and after playing the game. The serious game, co-designed with experts by lived experience, patient advocates and healthcare professionals, presented participants with a human anatomy diagram, with each section linked to a question about pancreatic cancer.

RESULTS

The serious game demonstrated a statistically significant improvement on pancreatic cancer awareness based on matched paired t-tests. Due to missing data, paired comparisons were only possible for 489 cases. Symptom awareness scores exhibited a statistically significant increase from pre-test to post-test, with a large effect size (p < 0.001, d = 1.43). Help-seeking intentions also markedly improved, showing a significant increase from pre-test to post-test, with a large effect size (p < 0.001, d = 1.10). Independent-samples t-tests were also conducted to determine if there were any group differences on pre- to post-test changes based on age, gender, and previous knowledge and/or experience of pancreatic cancer. Participants overwhelmingly endorsed the game's usability and educational value, suggesting its potential as an effective tool for enhancing public awareness and proactive health-seeking behaviour.

DISCUSSION

This study is the first to explore a serious game's utility in pancreatic cancer awareness. Results suggest that such interventions can effectively increase public awareness and influence help-seeking intentions. The co-design process ensured content relevance, and participant satisfaction was high. Findings highlight the game's potential as an accessible and convenient tool for diverse populations.

Education on Preventing Early Childhood Injuries Using a Video Game: The VirtualSafeHome Platform

Poisonings and household injuries are frequent events among toddlers. We developed VirtualSafeHome (VSH)-a novel self-contained, Internet-based home-safety learning tool-to improve awareness of household hazards. Study aims were to investigate VSH usage characteristics. A prototype, screen-based VSH kitchen was built in Unity and delivered through the web using 3DVista and Wix. Players spot and click 21 embedded hazards. A unique feature is the ability to capture the "child's perspective" in identifying hazards. We recruited a convenience sample of adults in 2021-2022. Outcomes included number of hazards discovered, session duration, and pretest/posttest knowledge scores. Twenty-four adults identified a median 15.5 hazards; median playing time was 1022 seconds. Players reported satisfaction with ease of navigation and game features. Mean pretest/posttest knowledge scores rose from 2.0 to 2.79 (P < .035). A web-enabled video game can provide easily accessed, enjoyable training on home safety.

A Serious Video Game Targeting HIV Testing and Counseling: A Randomized Controlled Trial

PURPOSE

Adolescents are the age group that is least likely to know their HIV status and may unknowingly transmit the virus to others. A randomized controlled trial was conducted to evaluate the impact of the original video game intervention, PlayTest!, on behavioral antecedents for HIV testing and counseling (HTC).

METHODS

Participants (N = 287 adolescents) were recruited between 2018 and 2020 and were 48% female, aged 14-18 years (mean age = 15.4 years), and 76% racial minorities. Participants were randomized 1:1 and assigned to either play PlayTest! or a set of control games, ∼one session per week for an hour per session over 4-6 weeks (gameplay) after school. The primary outcome measure was participants' attitudes around HTC at 6 months, with intentions, knowledge, self-efficacy, and behaviors assessed as secondary outcomes.

RESULTS

Two hundred and ninety-six participants were enrolled/randomized; nine were withdrawn due to incomplete parental consent forms, leaving 287 participants: 145 were randomized to PlayTest! and 142 to the control condition. Mixed between-within subjects ANOVAs assessed the impact of the study conditions on outcomes. Improvements were seen in the PlayTest! group in HTC attitudes (p < .001), intentions (p < .001), knowledge (p < .001), and self-efficacy (p = .002) at all time-points. At 6 months, for those who had access to HTC (N = 134; prior to COVID-19) and for those who did not have access to HTC (N = 261; during COVID-19), there were no differences in self-reported HTC between the two groups (p = .289 and p = .074, respectively).

DISCUSSION

PlayTest! impacted important behavioral antecedents related to HTC and has the potential to broadly increase HTC rates in adolescents.

Using Modern Learning Method to Teach Pharmacy Students Psychopharmacotherapy

Background

Applying modern educational methods for digital native students seems necessary. Active learning strategies promote students' skills and knowledge. This study was conducted to design and evaluate active learning methods by teaching psychopharmacotherapy to pharmacy students.

Methods

This was a quasi-experimental study with three randomized study groups (control, game, and multimedia), using a pre-and post-test design, conducted on 155 students of 5-year pharmacy in 2022 at the Faculty of Pharmacy of Tehran University of Medical Sciences, Iran. Overall, 18 clinical cases were designed for the basic structure of interventions. After teaching psychopharmacotherapy contents through lecturing, the pre-test was held. The next steps were playing the educational game, studying the multimedia case-based learning files, and then completing questionnaires, respectively. Then, a post-test was held.

Results

65.33% of participants were female and 34.66% were male. The pre-test and post-test scores comparison showed no difference in control group (P=0.409). However, in the serious game and multimedia groups, the average score of pre-test and post-test had a statistically significant difference (P<0.001, P=0.002 respectively), this difference was higher in the serious game group. Questionnaire evaluation showed substantial differences between game and multimedia groups.

Conclusion

The educational interventions were able to improve student's knowledge and skills so they can better help patients and promote public health. In the sections of Confidence, Social Interactions, Fun, Focused attention, Learnability, Relevance, and Perceived Learning, the serious game far outweighed the multimedia case-based learning.

An evaluation of the license to save lives program to promote organ, eye, and tissue donation among teenagers

As the number of designated organ donors continues to lag behind the number of waiting list patients, teenagers remain a promising demographic of potential organ donors. The current study enlisted Michigan and Ohio driver education students to participate in an online digital learning intervention, License to Save Lives (LTSL). Students were randomly assigned to either an interactive or noninteractive LTSL intervention. Across both states, the pretest-posttest design revealed greater knowledge among students following exposure to either the interactive or noninteractive LTSL program. No attitudinal or behavioral differences emerged between the interactive and noninteractive conditions. Michigan (39.82%) and Ohio (58.10%) students registered to be organ donors at a respectable rate. The results are discussed with an emphasis on feasibility and sustainability as well as the promise for digital games to promote organ donation knowledge, attitude, and registration among teenagers.

The Use of Gamification in the Self-Management of Patients With Chronic Diseases: Scoping Review

BACKGROUND

Chronic disease self-management is a public health issue of worldwide concern, and gamification is an emerging strategy to improve patients' participation in chronic disease self-management. Some studies have summarized designs for the gamification of chronic disease self-management from the perspective of eHealth technology, but they have not mentioned differences in design methods, functions, and evaluation methods of gamified designs for self-management in different chronic diseases.

OBJECTIVE

This scoping review aims to synthesize the characteristics of realization forms, functions, and evaluation methods in chronic disease self-management gamification to improve self-management among the chronic disease population.

METHODS

We applied a methodological framework for scoping reviews and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist. As of January 7, 2023, we systematically searched 9 databases for relevant studies from January 2012 to December 2022. Related data were extracted based on the research questions. We calculated the frequencies, charted the quantitative data, and coded the extracted material for qualitative content analysis.

RESULTS

We retrieved 16,221 records, of which 70 (0.43%) met the eligibility criteria. In the included research, the target populations for gamified designs for self-management of chronic diseases included patients with stroke, cancer, diabetes, chronic obstructive pulmonary disease, coronary heart disease, obesity, and hypertension. Almost all studies mentioned technical support for gamification (68/70, 97%), mainly in the form of active video games (58/70, 83%); however, less than half of the studies mentioned the theoretical basis for gamification (31/70, 44%). There were 37 concepts or theories relevant to gamification design, most of which were in the field of psychology or were cross-disciplinary (n=33, 89%). Gamification for the self-management of chronic diseases has been widely recognized, including for promoting physical exercise and rehabilitation training (48/99, 48%), increasing initiative for symptom management (18/99, 18%), providing psychological support (14/99, 14%), improving cognitive function (12/99, 12%), and improving medication adherence (7/99, 7%). A total of 39 studies mentioned the gamification effect; however, we did not find a unified evaluation standard.

CONCLUSIONS

This scoping review focuses on gamification designs for chronic disease self-management and summarizes the realization forms and functions of gamification in self-management for different patient populations. With practice in a gamified internet-based environment, patients can not only master the knowledge and skills of self-management in fascinating scenarios but also benefit from gaming experience and make better health-related decisions in real life. It is worth noting that a comprehensive evaluation of the users as well as a personalized and targeted intervention should be developed before gamification.

The person-centred care game: a reflective tool for learning person-centred care in higher education

Person-centred care (PCC) is being implemented within many health care systems and educational institutions are important enablers of learning PCC. Teachers in higher education are responsible for helping students develop the ability to reflect. One approach is with serious games, which allow students to reflect on realistic situations and shape their skills with virtual patients. This paper describes the development of a serious game, the person-centred care game - (PCC game), which was designed to promote learning of PCC by reflection. We demonstrated how this PCC game could be used to induce PCC knowledge and skills by student reflection in an academic course on PCC.

Increasing Access to Mental Health Services: Videogame Players' Perspectives

Young men's mental health is at the forefront of global public health concerns. Young males, who have a high incidence of mental health disorders, are a population that accesses services at lower rates than females and makes up the majority of videogame players. By considering the unique perspectives of digitally connected individuals on mental health service delivery, interventions may be designed to address their needs with a higher likelihood of success. This study investigated international male videogamers' perspectives on how their access to mental health services could be improved via an open-ended survey question. From a total of 2515 completed surveys, 761 responded to the qualitative question. Of these, the 71 responses that discussed access to and provision of mental healthcare services are reported in this article. Results suggest that digital mental health services were a promising way to reach this group. Anonymity and confidentiality were found to be important factors when considering online mental health services. Male videogame players identified a preference for both online and in-person services that are delivered synchronously, one-on-one with an expert practitioner, and readily available in settings that individuals find comfortable.

A Software Engineering Framework for Reusable Design of Personalized Serious Games for Health: Development Study

BACKGROUND

The use of serious games in health care is on the rise, as these games motivate treatment adherence, reduce treatment costs, and educate patients and families. However, current serious games fail to offer personalized interventions, ignoring the need to abandon the one-size-fits-all approach. Moreover, these games, with a primary objective other than pure entertainment, are costly and complex to develop and require the constant involvement of a multidisciplinary team. No standardized approach exists on how serious games can be personalized, as existing literature focuses on specific use cases and scenarios. The serious game development domain fails to consider any transfer of domain knowledge, which means this labor-intensive process must be repeated for each serious game.

OBJECTIVE

We proposed a software engineering framework that aims to streamline the multidisciplinary design process of personalized serious games in health care and facilitates the reuse of domain knowledge and personalization algorithms. By focusing on the transfer of knowledge to new serious games by reusing components and personalization algorithms, the comparison and evaluation of different personalization strategies can be simplified and expedited. In doing so, the first steps are taken in advancing the state of the art of knowledge regarding personalized serious games in health care.

METHODS

The proposed framework aimed to answer 3 questions that need to be asked when designing personalized serious games: Why is the game personalized? What parameters can be used for personalization? and How is the personalization achieved? The 3 involved stakeholders, namely, the domain expert, the (game) developer, and the software engineer, were each assigned a question and then assigned responsibilities regarding the design of the personalized serious game. The (game) developer was responsible for all the game-related components; the domain expert was in charge of the modeling of the domain knowledge using simple or complex concepts (eg, ontologies); and the software engineer managed the personalization algorithms or models integrated into the system. The framework acted as an intermediate step between game conceptualization and implementation; it was illustrated by developing and evaluating a proof of concept.

RESULTS

The proof of concept, a serious game for shoulder rehabilitation, was evaluated using simulations of heart rate and game scores to assess how personalization was achieved and whether the framework responded as expected. The simulations indicated the value of both real-time and offline personalization. The proof of concept illustrated how the interaction between different components worked and how the framework was used to simplify the design process.

CONCLUSIONS

The proposed framework for personalized serious games in health care identifies the responsibilities of the involved stakeholders in the design process, using 3 key questions for personalization. The framework focuses on the transferability of knowledge and reusability of personalization algorithms to simplify the design process of personalized serious games.

Making competency-based predoctoral orthodontics fun: Introducing Dealodontics

OBJECTIVES

Dealodontics is a card game developed at New York University College of Dentistry for dental students to reinforce and apply basic orthodontic concepts. Dealodontics incorporates clinical photographs and questions to assess students' skills in diagnosis and patient management. The game was designed to be an enjoyable, interactive, and collaborative learning experience, supplementing competency-based instruction. The purpose of this project was to present this novel educational method and to evaluate dental students' engagement and game-playing experience.

METHODS

The survey was modeled after the "Game Experience Questionnaire" and followed the same methodology collapsing 16 survey questions into eight categories. The 5-point Likert scale was collapsed into a 3-point graduated scale (negative, neutral, and positive). Results were tabulated and scored using methods developed by IJsselsteijn et.al. Comparisons were made between two years: 2019 (N = 385) and 2021 (N = 245). Additionally, students were asked an open-ended question, to list three words to describe the game-playing experience.

RESULTS

Response rates declined from 72% in 2019 to 50.2% in 2021. Response trends were similar: Positive gameplay experiences (competence, positive affect, immersion, challenge, and learning) and lack of negative experiences (tension/annoyance, negative affect). In the category of flow, 2021 responses were more positive (42.68%) when compared to the responses in 2019 (38.3%). Open-ended responses were similar with "fun" being the most commonly occurring word.

CONCLUSIONS

Dealodontics is an effective and engaging tool for learning which can be used to supplement traditional methods.

Implementation of game-based training in oral rehabilitation of edentulous patients in an undergraduate dental course

BACKGROUND

Coronavirus disease-19 dramatically changed the learning conditions of dental students, with restricted access to training sessions and clinical practice. The "Playdent" project proposed the integration of serious games (SGs) in the third-year curriculum, based on tailor-made scenarios questioning the first dental visit of edentulous patients, and examined whether training with the games would advance students' learning outcomes.

MATERIALS AND METHODS

Test scores of 89 students, allocated either to a "test" group that accessed SGs during a 4-week test period in addition to conventional lectures or to a "control" group that benefited solely from conventional lectures, were measured before and immediately after the test period. The subsequent satisfaction of students was assessed in the "test" group.

RESULTS

Scores obtained after the 4-week period significantly increased within the "test" group (11.1% ± 24.9%, p = 0.04, degree of freedom [df] = 30) while they did not change within the "control" group (p = 0.21, df = 57). Qualitative feedback expressed by students who played SGs during the 4-week period demonstrated that 71% of them rated the SGs as satisfactory and 91% of them judged the consistency of SGs content with lectures to be satisfactory.

CONCLUSION

Game-based learning showed a positive impact on the learning outcomes of third-year students. Qualitative assessments provide insights into the pertinence of SGs offered in addition to traditional lectures of third-year complete denture courses. SGs may consolidate skills in oral rehabilitation acquired through traditional passive learning formats proposed in preclinical courses.

Construcción y validación de un juego educativo sobre sexualidad para adolescentes

Introducción: la educación en salud de los adolescentes con enfoque en la sexualidad se ve favorecida por el uso de tecnologías cuidado - educativas. Objetivo: construir y validar una tecnología educativa, a modo de juego de mesa, para mediar en la discusión de temas relacionados a la sexualidad con la población adolescente. Materiales y métodos: estudio metodológico planteado en tres etapas, a saber: 1ª) delimitación del contenido a abordar, 2ª) creación del prototipo del juego, 3ª) validación del contenido y apariencia por jueces expertos. Resultados y discusión: “Match” es un juego de mesa, con preguntas temáticas relacionadas con la sexualidad que dirigen al jugador desde el principio hasta el final del viaje. Se hizo hincapié en la incorporación de elementos de gamificación, como la suerte, la estrategia, la competencia y la cooperación. El proceso de validación fue exitoso en todas las categorías evaluadas, el juego fue considerado relevante y adecuado para actividades de educación en salud. Conclusiones: el juego desarrollado está validado y disponible para la comunidad científica y profesional, y sus efectos deben medirse en las próximas etapas de la investigación. Además, se debe construir una versión digital de la herramienta para aumentar su alcance. Como citar este artículo: Alencar, Nadyelle Elias Santos; Pinto, Maria Aparecida Oliveira; Leite, Nicácio Torres; Silva, Claudia Maria Vieira da.  Construção e validação de jogo educativo sobre sexualidade para adolescentes. Revista Cuidarte. 2023;14(1):e2354. http://dx.doi.org/10.15649/cuidarte.2354

Exploring the use of games in palliative care: A scoping review

OBJECTIVE

There has been increasing recognition of the potential of games in health; however, knowledge of their application in palliative care is lacking. Therefore, this study aimed to identify and map the available evidence on the use of games in palliative care, analyzing how research has been conducted on this topic and identifying gaps in knowledge.

METHOD

A scoping review was carried out. The literature search was conducted using the respective descriptors and search syntax appropriate to each of the databases searched. The review included all study types with no time limits.

RESULTS

Of the 685 articles initially identified, 53 were included for final analysis. Several different game types were identified, with the majority of studies using role-play (n = 29) and card games (n = 17). The games analyzed were essentially aimed at empowering patients (n = 14), and in some cases, extended to families or caregivers, as well as to medical and nursing students. The analysis of the articles in this review resulted in two major themes: Role-playing for training in palliative care and card games to discuss end-of-life care.

SIGNIFICANCE OF RESULTS

Games allow space for the expression of emotions and promote creativity. They can be applied both in a training context, to enable health professionals to develop essential skills in palliative care, and for patients, families, and caregivers, allowing them to talk about serious things while playing.

Who Engages and Why It Matters?

While the use and benefits of serious games in health care are increasingly recognized, the impact of individuals' game engagement remains understudied, limiting the potential for impact. This pilot study aims to describe game engagement and its associations with learning outcomes, sociodemographics, and health factors in women with advanced cancer receiving a 12-week self-advocacy serious game intervention. Game engagement was collected from study tablets and weekly self-reported surveys. Participants' game engagement was overall high but with large amounts of variation and did not differ by their sociodemographics and health factors. Participants with lower baseline symptom severity were more likely to repeat game scenarios, and those who engaged in all scenarios had higher connected strength post-intervention. Knowing what prevents patients with advanced cancer from engaging in the serious game enlightens ways to refine the gamified interventions. Future research is suggested to evaluate patients' engagement to deepen understanding of its impacts on learning outcomes.

The person-centred care game: a reflective tool for learning person-centred care in higher education

Teachers in higher education are responsible for helping students develop the ability to reflect. One approach is with serious games, which allow students to reflect on realistic situations and shape their skills with virtual patients. This paper describes the development of a serious game, the person-centred care game – (PCC game), which was designed to promote reflection in learning. We demonstrated how this PCC game could be used to induce student reflection in an academic course on PCC.

Evaluation of the effectiveness of the serious game aleitagame as an educational resource in teaching about mammillary injuries

ABSTRACT Objective to evaluate the effectiveness of an educational intervention using the serious game AleitaGame as an educational resource in teaching about mammillary injuries. Method a quasi-experimental, single group, before and after, non-randomized study, developed between August and October 2021. The intervention was carried out with 43 professionals working in a hospital in Rio Grande do Norte. Data were analyzed using descriptive and inferential statistics. Results the educational resource had a positive effect, with a significant increase in the knowledge of the participants of the educational intervention (p<0.05). Regarding the evaluation of participants' satisfaction about AleitaGame as an educational resource, most participants considered all items in the “content”, “language”, “organization and layout”, “motivation and learning” categories to be excellent. Conclusion and implications for practice the results of the study are inviting criteria for professors in the area to start incorporating AleitaGame in their classrooms, as well as for using the resource as a strategy for the continuing education of professionals in health services. The serious game is available on the link: <https://aleitagame.github.io/>.

Teamwork Training With a Multiplayer Game in Health Care: Content Analysis of the Teamwork Principles Applied

BACKGROUND

In health care, teamwork skills are critical for patient safety; therefore, great emphasis is placed on training these skills. Given that training is increasingly designed in a blended way, serious games may offer an efficient method of preparing face-to-face simulation training of these procedural skills.

OBJECTIVE

This study aimed to investigate the teamwork principles that were used during gameplay by medical students and teamwork experts. Findings can improve our understanding of the potential of serious games for training these complex skills.

METHODS

We investigated a web-based multiplayer game designed for training students' interprofessional teamwork skills. During gameplay, 4 players in different roles (physician, nurse, medical student, and student nurse) had to share information, prioritize tasks, and decide on next steps to take in web-based patient scenarios, using one-to-one and team chats. We performed a qualitative study (content analysis) on these chats with 144 fifth-year medical students and 24 health care teamwork experts (as a benchmark study) playing the game in groups of 4. Game chat data from 2 scenarios were analyzed. For the analysis, a deductive approach was used, starting with a conceptual framework based on Crew Resource Management principles, including shared situational awareness, decision-making, communication, team management, and debriefing.

RESULTS

Results showed that most teamwork principles were used during gameplay: shared situational awareness, decision-making (eg, re-evaluation), communication (eg, closed loop), and team management (eg, distributing the workload). Among students, these principles were often used on a basic level. Among experts, teamwork principles were used with more open forms of speak up and more justification of decisions. Some specific Crew Resource Management principles were less observed among both groups, for example, prevention of fixation errors and use of cognitive aids. Both groups showed relatively superficial debriefing reflections.

CONCLUSIONS

Playing a multiplayer game for interprofessional teamwork appears to facilitate the application of teamwork principles by students in all important teamwork domains on a basic level. Expert players applied similar teamwork principles on a moderately high complexity level. Some teamwork principles were less observed among both students and expert groups, probably owing to the artifacts of the game environment (eg, chatting instead of talking). A multiplayer game for teamwork training can elicit the application of important, basic teamwork principles, both among novices and experts, and provides them with a flexible, accessible, and engaging learning environment. This may create time for exercising more complex skills during face-to-face training.

Deep Reinforcement Learning-Based iTrain Serious Game for Caregivers Dealing with Post-Stroke Patients

This paper describes a serious game based on a knowledge transfer model using deep reinforcement learning, with an aim to improve the caretakers’ knowledge and abilities in post-stroke care. The iTrain game was designed to improve caregiver knowledge and abilities by providing non-traditional training to formal and informal caregivers who deal with stroke survivors. The methodologies utilized professional medical experiences and real-life evidence data gathered during the duration of the iTrain project to create the scenarios for the game’s deep reinforcement caregiver behavior improvement model, as well as the design of game mechanics, game images and game characters, and gameplay implementation. Furthermore, the results of the game’s direct impact on caregivers (n = 25) and stroke survivors (n = 21) in Lithuania using the Geriatric Depression Scale (GDS) and user experience questionnaire (UEQ) are presented. Both surveys had favorable outcomes, showing the effectiveness of the approach. The GDS scale (score 10) revealed a low number of 28% of individuals depressed, and the UEQ received a very favorable grade of +0.8.

Artificial Intelligence-Driven Serious Games in Health Care: Scoping Review

BACKGROUND

Artificial intelligence (AI)-driven serious games have been used in health care to offer a customizable and immersive experience. Summarizing the features of the current AI-driven serious games is very important to explore how they have been developed and used and their current state to plan on how to leverage them in the current and future health care needs.

OBJECTIVE

This study aimed to explore the features of AI-driven serious games in health care as reported by previous research.

METHODS

We conducted a scoping review to achieve the abovementioned objective. The most popular databases in the information technology and health fields (ie, MEDLINE, PsycInfo, Embase, CINAHL, IEEE Xplore, ACM Digital Library, and Google Scholar) were searched using keywords related to serious games and AI. Two reviewers independently performed the study selection process. Three reviewers independently extracted data from the included studies. A narrative approach was used for data synthesis.

RESULTS

The search process returned 1470 records. Of these 1470 records, 46 (31.29%) met all eligibility criteria. A total of 64 different serious games were found in the included studies. Motor impairment was the most common health condition targeted by these serious games. Serious games were used for rehabilitation in most of the studies. The most common genres of serious games were role-playing games, puzzle games, and platform games. Unity was the most prominent game engine used to develop serious games. PCs were the most common platform used to play serious games. The most common algorithm used in the included studies was support vector machine. The most common purposes of AI were the detection of disease and the evaluation of user performance. The size of the data set ranged from 36 to 795,600. The most common validation techniques used in the included studies were k-fold cross-validation and training-test split validation. Accuracy was the most commonly used metric for evaluating the performance of AI models.

CONCLUSIONS

The last decade witnessed an increase in the development of AI-driven serious games for health care purposes, targeting various health conditions, and leveraging multiple AI algorithms; this rising trend is expected to continue for years to come. Although the evidence uncovered in this study shows promising applications of AI-driven serious games, larger and more rigorous, diverse, and robust studies may be needed to examine the efficacy and effectiveness of AI-driven serious games in different populations with different health conditions.

An Augmented Reality Serious Game for Learning Intelligent Wheelchair Control: Comparing Configuration and Tracking Methods

This work proposes an augmented reality serious game (ARSG) for supporting individuals with motor disabilities while controlling robotic wheelchairs. A racing track was used as the game narrative; this included restriction areas, static and dynamic virtual objects, as well as obstacles and signs. To experience the game, a prior configuration of the environment, made through a smartphone or a computer, was required. Furthermore, a visualization tool was developed to exhibit user performance while using the ARSG. Two user studies were conducted with 10 and 20 participants, respectively, to compare (1) how different devices enable configuring the ARSG, and (2) different tracking capabilities, i.e., methods used to place virtual content on the real-world environment while the user interacts with the game and controls the wheelchair in the physical space: C1-motion tracking using cloud anchors; C2-offline motion tracking. Results suggest that configuring the environment with the computer is more efficient and accurate, in contrast to the smartphone, which is characterized as more engaging. In addition, condition C1 stood out as more accurate and robust, while condition C2 appeared to be easier to use.

Preliminary User Evaluation of a New Dental Technology Virtual Simulation System: Development and Validation Study

BACKGROUND

With the advancements in the dental health care industry, the demand for dental technicians has increased. Dental technicians should be thoroughly assessed and trained in practical skills and pass professional certification examinations to ensure that they are competent to work closely with dentists. Unfortunately, such training courses and tests are in short supply worldwide. The use of virtual simulation technology can help solve these problems.

OBJECTIVE

This study presents a new strategic framework design for a certified dental technician practical examination called as the certified Objective Manipulative Skill Examination of Dental Technicians (OMEDT), which is based on the Objective Structured Clinical Examination (OSCE). We present the development and validation of the OMEDT system, a new virtual simulated training system, to meet the demands of the OMEDT framework. The combination of OMEDT and the OMEDT system can solve the complex problems encountered in the certified dental technician practical examination with excellent efficiency, high quality, and low cost.

METHODS

The OMEDT framework design was constructed according to the OSCE guide and the Chinese vocational skill standards for dental technicians. To develop the OMEDT system, we organized a new framework based on the virtual learning network platform, the haptic feedback system, and the real-time dental training and evaluation system. The effectiveness evaluation of the OMEDT system was divided into 2 phases: in the first phase, 36 students were recruited to use the test module to finish the task and their performance data were collected and analyzed; and in the second phase, a questionnaire was administered to 30 students who used the system for their studies and graduation exams.

RESULTS

The OMEDT and the corresponding skill training virtual simulation OMEDT system were developed, and preliminary user evaluation was performed to assess their effectiveness and usefulness. The OMEDT system was found to improve students' practical skills by training with the evaluation results. In addition, several key research topics were explored, including the effects of positive feedback of the knowledge of results on the improvement of the students' skill level and the common sense transformation of educators in the virtual simulation technology environment.

CONCLUSIONS

The development of OMEDT and the OMEDT system has been completed and their effectiveness has been verified.

Serious games for sex education of adolescents and youth: integrative literature review

This study aims to map educational games related to the sexuality of adolescents/young people, based on publications that occurred over the last decade (2011 to 2020). An integrative review was performed in the Web of Science, SCOPUS, MEDLINE/PubMed, and LILACS databases in September 2020, with the final inclusion of 16 studies. Games developed on four continents were identified, predominantly in high-income countries, with the United States of America and Brazil being those that published the most. The tools consisted mostly of videogames and digital games, with the adoption of simulated scenarios and plots. Regarding development, there was a preference for the participatory construction mode, while some also underwent a validation process. The tools addressed several areas of human sexuality and demonstrated a positive potential for use, with educational gains and changes in habits, but their results need to be carefully considered. Only the effects of three games were evaluated by randomized controlled trials.

Serious games for sex education of adolescents and youth: integrative literature review

Abstract This study aims to map educational games related to the sexuality of adolescents/young people, based on publications that occurred over the last decade (2011 to 2020). An integrative review was performed in the Web of Science, SCOPUS, MEDLINE/PubMed, and LILACS databases in September 2020, with the final inclusion of 16 studies. Games developed on four continents were identified, predominantly in high-income countries, with the United States of America and Brazil being those that published the most. The tools consisted mostly of videogames and digital games, with the adoption of simulated scenarios and plots. Regarding development, there was a preference for the participatory construction mode, while some also underwent a validation process. The tools addressed several areas of human sexuality and demonstrated a positive potential for use, with educational gains and changes in habits, but their results need to be carefully considered. Only the effects of three games were evaluated by randomized controlled trials.

Communicating with Community: Health Disparities and Health Equity Considerations

This article explores why communicating with communities is important to the health of individuals as well as public health, and best practices of how. We outline the use of relevant theoretic frameworks, understanding the role of technological contextual changes, trust despite misinformation, health and digital literacy skills, and working with the community for effective reciprocal communication. Strategies for developing community communication are also enumerated and applied to addressing health disparities.

Digital serious games in developing nursing clinical competence: A systematic review and meta-analysis

OBJECTIVE

This review aimed to synthesise evidence from experimental studies of the application of digital serious games in developing nursing clinical competence.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

Eight databases were searched for randomized controlled trials and quasi-experimental studies published in English from 2000 to 2021.

REVIEW METHODS

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were adopted in this review. Quality appraisal was conducted using Cochrane's Risk of Bias tool and the Joanna Brigg's Institute Critical Appraisal Tool for Quasi-Experimental Designs. A narrative synthesis of studies, and a meta-analysis and subgroup analysis, was performed on the study outcomes.

RESULTS

22 experimental studies including 13 randomized controlled trials and nine quasi-experimental studies were included. Of these, 19 studies examined nursing students and three examined qualified nurses. These studies applied serious games to develop nursing competencies in management of nursing care, clinical reasoning skills, procedural skills, legal practice and quality improvement. Compared with control groups, serious games improved knowledge (SMD = 1.30, 95% CI [0.75, 1.86]) and skills (SMD = 0.38, 95% CI [0.17, 0.60]). Subgroup analysis for both knowledge and skills outcomes demonstrated that serious games were more effective than control groups with either no intervention or other educational interventions. A large effect size (SMD = 1.13, 95% CI [0.91, 1.34]) was found in favour of serious games for improving knowledge scores in management of nursing care.

CONCLUSION

The reviewed studies identified a broad application of digital serious games for developing nursing competencies. The knowledge and skills performance outcomes supported the use of serious games, which were found to be superior to conventional educational interventions. More serious games are required to be incorporated into undergraduate and continuing nursing education for workplace training, with more rigorous studies examining the effect of serious games in improving the quality and safety of clinical nursing practice.

Artificial Intelligence-Driven Serious Games in Healthcare: A Scoping Review (Preprint).. [DOI: 10.2196/preprints.39840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

BACKGROUND

Artificial Intelligence (AI)-driven serious games have been used in healthcare to offer a customizable and immersive experience. Summarizing the features of the current AI-driven serious games is very important to explore how they have been developed and used and their current state in order to plan on how to leverage them in the current and future healthcare needs.

OBJECTIVE

The current study aimed to explore the features of AI-driven serious games in healthcare as reported by previous research.

METHODS

We carried out a scoping review to achieve the above-mentioned objective. The most popular databases in information technology and health fields (e.g., MEDLINE and IEEE Xplore) were searched using keywords related to serious games and AI. These terms were selected based on the target intervention (i.e., AI) and the target disease (i.e., COVID-19). Two reviewers independently performed the study selection process. Three reviewers independently used Microsoft Excel to extract data from the included studies. A narrative approach was used for data synthesis.

RESULTS

The search process returned 1470 records. Of these records, 46 met all eligibility criteria. 60 different serious games were found in the included studies. Motor impairment was the most common health condition targeted by these serious games. Serious games in most of the studies were used for rehabilitation. The serious games in the majority of the included studies can be played by only single player. Most serious games were played on standalone devices (offline games). The most common genres of serious games were role-playing games, puzzle games, and platformer games. Unity was the most prominent game engine used to develop serious games. Personal computers (PCs) were the most common platforms used to play serious games. The most common algorithms used in the included studies were Support Vector Machine (SVM), Convolutional Neural Network (CNN), Artificial Neural Networks (ANN), and Random Forest (RF). The most common purposes of AI were the detection of disease and the evaluation of user's performance. The dataset size ranged from 36 to 795,600, with an average of about 52,124. The most common validation techniques used in the included studies were K-fold cross-validation and training test split validation. Accuracy was the most commonly used metric to evaluate the performance of AI models.

CONCLUSIONS

The last decade witnessed an increase in the development of AI-driven serious games for healthcare purposes and targeting various health conditions and leveraging multiple AI algorithms; this rising trend is expected to continue for years to come. While the evidence uncovered in this study shows promising applications of AI-driven serious games, larger and more rigorous, diverse, and robust studies may be needed to examine the efficacy and effectiveness of AI-driven serious games in different populations with different health conditions.

Development of and User Feedback on a Board and Online Game to Educate on Antimicrobial Resistance and Stewardship

Antimicrobial resistance (AMR), particularly antibiotic resistance, is one of the most challenging global health threats of our time. Tackling AMR requires a multidisciplinary approach. Whether a clinical team member is a cleaner, nurse, doctor, pharmacist, or other type of health worker, their contribution towards keeping patients safe from infection is crucial to saving lives. Existing literature portrays that games can be a good way to engage communities in joint learning. This manuscript describes an educational antimicrobial stewardship (AMS) game that was co-created by a multidisciplinary team of health professionals spanning across high- and low- to middle-income countries. The online AMS game was promoted and over 100 players across 23 countries registered to participate on 2 occasions. The players were asked to share feedback on the game through a short online form. Their experiences revealed that the game is relevant for creation of awareness and understanding on antimicrobial stewardship in both high- and low-to-middle income settings worldwide.

Development and questionnaire-based evaluation of virtual dental clinic: a serious game for training dental students

BACKGROUND

The volume of literature about serious gaming in dental education has increased, however, none of the previous studies have developed a serious game for closing the gap between preclinical and clinical training.

OBJECTIVE

Virtual Dental Clinic (VDC) is a serious game that was created to help develop clinical reasoning skills in dental students. This study aimed to evaluate VDC as an educational tool and its effectiveness on clinical skill and knowledge gain among clerkship dental students.

METHODS

The following three stages of VDC design and testing were addressed from 2016 to 2020: development, validation, and application. The VDC was developed using Unity game engine. In the validation stage, the content validity was reviewed by five visiting staff; construct validity and face validity were examined by 9 postgraduate-year dentists and 14 clerkship dental students. Concurrent validity and predictive validity were examined by 34 fifth-year dental students during their clerkship from September, 2018 to May, 2019, the associations between VDC experiences, clerkship performance, and the score on a national qualification test were explored. In the application stage, the VDC was set up as a self-learning tool in the Family Dentistry Department from August, 2019, quantitative and qualitative analyses were conducted using the 92 clerkship students' feedback.

RESULTS

The VDC showed good validity and a high potential for education in practice. Students who have used VDC received significantly higher scores on qualification test (p = 0.029); the VDC experiences significantly predicted higher performance score on periodontics (p = 0.037) and endodontics (p = 0.040). After the outbreak of COVID-19 pandemic, significantly higher proportion of students confirmed the value of VDC as an assistant tool for learning clinical reasoning (p = 0.019).

CONCLUSIONS

The VDC as an educational tool, and the effectiveness on clinical reasoning skills and knowledge gain among clerkship dental students has been validated and confirmed in this study.

Gamifying Sexual Education for Adolescents in a Low-Tech Setting: Quasi-Experimental Design Study

BACKGROUND

Sexual education has become increasingly important as unhealthy sexual practices and subsequent health risks become more prevalent during adolescence. Traditional sex education teaching methodologies are limiting for digital natives exposed to various digital technologies. Harnessing the power of technology applications attractive to the younger generation may be a useful approach for teaching sex education.

OBJECTIVE

The aim of this study was to improve sexual health knowledge and understanding of the problems associated with unhealthy sexual practices and address sexual and reproductive health challenges experienced in a low-tech setting.

METHODS

A participatory design approach was used to develop the digital gamified methodology. A sample of 120 secondary school students aged 11-15 were randomly assigned to either experimental or control group for each of the 3 teaching approaches: (1) gamified instruction (actual serious games [SG] in teaching); (2) gamification (GM; making nongames, such as game-like learning); and (3) traditional teaching (TT) methods.

RESULTS

The SG and GM approaches were more effective than TT methods in teaching sexual health education. Specifically, the average scores across groups demonstrated an increase of mean scores from the pre- to posttest (25.10 [SD 5.50] versus 75.86 [SD 13.16]; t₁₁₉=41.252; P<.001 [2 tailed]). Analysis of variance indicated no significant differences across groups for pretest scores (F_2,117=1.048, P=.35). Significant differences across groups were evident in the posttest scores. Students in the SG and GM groups had higher average scores than the TT group (F_2,117=83.98; P<.001). Students reported increased learning motivation, attitude, know-how, and participation in learning (P<.001) when using SG and GM approaches.

CONCLUSIONS

Digital health technologies (particularly teaching and learning through gamified instruction and other novel approaches) may improve sexual health education. These findings may also be applied by practitioners in health care settings and by researchers wishing to further the development of sex education.

Conceptual Ambiguity Surrounding Gamification and Serious Games in Health Care: Literature Review and Development of Game-Based Intervention Reporting Guidelines (GAMING)

BACKGROUND

In health care, the use of game-based interventions to increase motivation, engagement, and overall sustainability of health behaviors is steadily becoming more common. The most prevalent types of game-based interventions in health care research are gamification and serious games. Various researchers have discussed substantial conceptual differences between these 2 concepts, supported by empirical studies showing differences in the effects on specific health behaviors. However, researchers also frequently report cases in which terms related to these 2 concepts are used ambiguously or even interchangeably. It remains unclear to what extent existing health care research explicitly distinguishes between gamification and serious games and whether it draws on existing conceptual considerations to do so.

OBJECTIVE

This study aims to address this lack of knowledge by capturing the current state of conceptualizations of gamification and serious games in health care research. Furthermore, we aim to provide tools for researchers to disambiguate the reporting of game-based interventions.

METHODS

We used a 2-step research approach. First, we conducted a systematic literature review of 206 studies, published in the Journal of Medical Internet Research and its sister journals, containing terms related to gamification, serious games, or both. We analyzed their conceptualizations of gamification and serious games, as well as the distinctions between the two concepts. Second, based on the literature review findings, we developed a set of guidelines for researchers reporting on game-based interventions and evaluated them with a group of 9 experts from the field.

RESULTS

Our results show that less than half of the concept mentions are accompanied by an explicit definition. To distinguish between the 2 concepts, we identified four common approaches: implicit distinction, synonymous use of terms, serious games as a type of gamified system, and distinction based on the full game dimension. Our Game-Based Intervention Reporting Guidelines (GAMING) consist of 25 items grouped into four topics: conceptual focus, contribution, mindfulness about related concepts, and individual concept definitions.

CONCLUSIONS

Conceptualizations of gamification and serious games in health care literature are strongly heterogeneous, leading to conceptual ambiguity. Following the GAMING can support authors in rigorous reporting on study results of game-based interventions.

Enhancing instructional outcomes with a serious gamified system: a qualitative investigation of student perceptions

Purpose

This paper aims to evaluate the students’ perception of their learning experiences concerning serious gaming and gamification instructions and determines whether they were motivated enough and engaged during the educative process in a resource-poor context. Moreover, the study evaluated the impact of interactive instructional environment outcomes in terms of students’ perceptions of the learning catalysed by gamified systems, particularly in enhancing attitude change coupled with knowledge acquisition.

Design/methodology/approach

This study used a qualitative research design technique to collect the data. A total of 108 first year secondary school students participated in a sexual health literacy course that lasted for a five-week learning period. Using a cluster-sampling technique, three classes were randomly assigned to serious gaming, gamification and teacher-centred instructions. Individual face-to-face interviews were used to assess students’ perceives required satisfaction with three instructions. Data were audio-recorded, and coding analysis was used using NVivo software facilitated qualitative data analysis.

Findings

The results show that serious gaming and gamification instructions trumped the traditional teacher-centred instruction method. While intervention students were all positive about the serious gaming and gamification instructions, non-intervention students were negative about conservative teacher-centered learning whose limited interactivity also undermined learning relative to the two innovative interventions.

Research limitations/implications

As a justification to limit face-to-face classes, this study may be useful during an emergency phenomenon, including the current situation of amid COVID-19. The implementation of serious gaming and gamification as remotely instructional options could be among the measures to protect educational communities through reducing close-proximity, and eventually, control contamination and the spread of viruses.

Originality/value

The application of serious gaming and game elements should not be conceptualised as universal but context-specific. This study shows that particularism is essential to optimise the results in terms of coming up with a specific design based on the scope of evaluation for positive results and develop an intervention that will work, especially in the resource-poor context of the developing world.