Interactive games to promote behavior change in prevention and treatment.
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ABSTRACT: Background Computerised cognitive behavioural therapy (cCBT) has the potential to increase access to therapy for underserved groups. We aimed to explore the views of adolescents attending alternative education (AE) programmes who participated in a trial of immediate compared with delayed cCBT (SPARX).Methods Semi-structured interviews and brief satisfaction questionnaires were completed post-cCBT (n = 39, 24 male, 15 Māori, 12 Pacific Island, 30 with Children's Depression Rating Scale scores indicating symptoms of depression, all 13–16 years old). Interview findings were analysed using a general inductive analysis.ResultsThose with and those without symptoms had similar views. Most reported they completed all seven levels of cCBT and experienced it as helpful and fun. Most considered that cCBT had benefited them, primarily in terms of increased calmness or reduced anger and fighting. Participants described cCBT as different from counselling, with cCBT seen as freeing and empowering although potentially less responsive to personal needs. Most considered that cCBT might increase help-seeking and thought it should be offered to all their peers as targeting individuals would not succeed and all would benefit.Conclusions Educationally alienated adolescents considered cCBT beneficial and thought it should be offered universally in AE and similar programmes. SPARX youtube video: https://www.youtube.com/watch?v=xu7dvRS8It4Clinical Psychologist 02/2015; · 0.43 Impact Factor
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ABSTRACT: The usefulness and effectiveness of specific serious games in the medical domain is often unclear. This is caused by a lack of supporting evidence on validity of individual games, as well as a lack of publicly available information. Moreover, insufficient understanding of design principles among the individuals and institutions that develop or apply a medical serious game compromises their use. This article provides the first consensus-based framework for the assessment of specific medical serious games. The framework provides 62 items in 5 main themes, aimed at assessing a serious game's rationale, functionality, validity, and data safety. This will allow caregivers and educators to make balanced choices when applying a serious game for healthcare purposes. Furthermore, the framework provides game manufacturers with standards for the development of new, valid serious games. (JMIR Serious Games 2014;2(2):e11) doi:10.2196/games.3825JMIR Serious Games. 11/2014; 2(2):2014.
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ABSTRACT: Serious games (computerised interventions which utilise gaming for serious purposes) have been shown to support improved outcomes in several health conditions. We aimed to review evidence regarding serious games for depression. We undertook electronic searches of PsycInfo, EMBASE and Medline, using terms relevant to computer games and depression. We included fulltext articles published in English in peer-reviewed literature since 2000, where the intervention was designed to treat or prevent depression and which included pre-and post-intervention measurement of depression. Nine studies relating to a total of six interventions met inclusion criteria. Most studies were small and were carried out by the developers of the programs. All were tested with young people (ages between 9 and 25 years). Most reported promising results with some positive impact on depression although one universal program had mixed results. Serious gaming interventions show promise for depression, however evidence is currently very limited.Revista de Psicopatología y Psicología Clínica 01/2014; 19(3). · 0.23 Impact Factor
Interactive Games to Promote Behavior
Change in Prevention and Treatment
J. Leighton Read, MD
Stephen M. Shortell, PhD, MBA, MPH
ness disappears. Csikszentmihalyi described this state as
“flow.”1His concept was exemplified by mountain climb-
cate and demanding task. He could just as well have been
of today’s interactive games.
Games are now a dominant form of media, even larger
than the motion picture industry, and are enjoyed across
gender, age, and cultural boundaries. Zynga Inc, a Face-
book game developer, claims 215 million players world-
targeting healthy behaviors are also proliferating. For ex-
ample, Web-based games offered by Humana, the large in-
diet and exercise. Other games are appearing on consoles,
robots, and medical devices.
Such games deserve serious attention, because clini-
cians and policy makers will be confronted with decisions
regarding their use. There is great promise in channeling
hance the effectiveness of health messaging, allowing indi-
viduals to practice useful thought patterns and behaviors
and encouraging them to explore and learn from failure in
safe virtual environments.
The efficacy and mechanism of action of games target-
ing health outcomes are not well defined. Time spent play-
ing entertainment games can enhance psychomotor skills,
collaboration.3However, evidence also exists for the nega-
tive influence such media exposure can have on the health
of children, particularly those exposed to themes of vio-
lence and aggression.4
NYONE WHO HAS OBSERVED SOMEONE DEEPLY AB-
sorbed in a video game can appreciate that use of
the player, time stands still and self-conscious-
Successful entertainment game designs draw on a well-
understood set of features, such as a narrative setting that
motivates goals, systems of feedback, points, levels, com-
petition, teamwork, trading, and often, self-representation
using an avatar.3The extent to which a game is engaging
(and useful for health objectives) depends on the skill with
which these are implemented as a package for a particular
To date, the evidence base of studies evaluating games is
limited, and only a few health games have been subject to
rigorous evaluation. One study evaluated Packy & Marlon,
a Nintendo console game published in 1994 that allowed
participants who played the game had a 77% reduction in
visits.5A school-based computer game for fourth-graders
improved daily fruit and vegetable intake.6More recently,
Re-Mission, a game for adolescent and young adult patients
with cancer, has been shown in a randomized trial to im-
pad platforms, have been shown to increase physical activ-
ity and may have benefits for treating obesity.8
Interactive games are rapidly exploiting new technology.
Global Positioning System (GPS) technology in new smart-
phones is spawning a host of location-based games as well
as physical activity–tracking applications that record dis-
tance hiked, run, or skied. Accelerometers that turn cell
phones into sophisticated pedometers are just beginning to
be incorporated into games to promote healthy behavior.
Some investigators are evaluating efficacy of games that use
dedicated sensors measuring heart rate or expiratory vol-
ume that can upload data to the Web via wireless hotspots,
cell phones, or personal computers. For example, Zamzee is
an online rewards system for 11- to 14-year-olds based on
physical activity using a pocket monitor. At Cornell Uni-
versity, adolescents playing the Mindless Eating Challenge
and School of Public Health, University of California, Berkeley (Dr Shortell).
Corresponding Author: J. Leighton Read, MD, Alloy Ventures, 400 Hamilton Ave,
Ste 400, Palo Alto, CA 94301 (firstname.lastname@example.org).
©2011 American Medical Association. All rights reserved.
JAMA, Published online March 29, 2011
by guest on April 12, 2011jama.ama-assn.orgDownloaded from
receive peer support by sharing cell phone photographs of
portion size and ingredients. Investigators at Columbia
University are testing Lit to Quit, an ingenious game in
which smokers trying to quit can puff into an iPhone
microphone instead of a cigarette and in 2 game versions
use a “rush” or a “relax” form of breathing that helps
reduce cravings. In “alternative reality” games, experience
comes from the Web and from e-mails and telephone calls
from the game and, increasingly, action is connected to the
physical world via sensors. For example, at Indiana Univer-
sity, students are participating via these media in an investi-
gational interactive mystery game that promotes healthy
eating and exercise.
The Robert Wood Johnson Foundation is encouraging a
understanding how various game design elements contrib-
ment based on behavior change. The recently passed Af-
fordable Care Act includes $10 billion for disease preven-
tion and health promotion over the next 5 years. Health
games represent an emerging tool that must be considered
by community health centers, accountable care organiza-
premiums on clinical services or on activities that improve
health care quality. Under these “medical loss ratio” rules,
health games could qualify as health promotion programs,
In summary, the substantial growth of new interactive
game technologies and genres raises new concerns and op-
portunities. The size and level of engagement of the audi-
ence means that health games can affect a wide range of in-
dividuals, including those who are difficult to reach with
traditional messaging. Powerful technology can also have
unintended consequences. Exercise games could work too
This is just the early stage of knowing how to create and
deploy applications that actually deliver health benefits.
Additional investigation is necessary to determine whether
and how to integrate effective interactive games into clini-
cal care settings and community programs without dis-
rupting trusted relationships with clinicians. To create the
foundation for evidence-based design, use, and refinement
of these promising technologies, further studies will need
to address questions about mechanism of action, efficacy,
and safety across the range of uses and participant demo-
graphics. In the meantime, those offering health games
should at least make the key design principles and objec-
tives available to health professionals to enable a common-
sense evaluation of suitability.
Published Online: March 29, 2011. doi:10.1001/jama.2011.408
Conflict of Interest Disclosures: The authors have completed and submitted the
ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Read reported that
he is a venture partner for Alloy Ventures, a venture capital firm investing in bio-
medical and information technology companies, but none of these companies cur-
rently are involved in health promotion activities as described in this article; that
he is Chairman and the major stakeholder of Seriosity Inc, a private company fo-
cused on developing games for employee engagement in large enterprises, but
has not conducted any business or received revenue to date for any health-
related games as described in this article; and that he was a consultant for the Rob-
ert Wood Johnson Foundation in 2008-2010, serving as chair of National Advi-
speaking fees, and travel reimbursement. Dr Shortell reported no disclosures.
Additional Contributions: We thank Debra Lieberman, PhD (Health Games Re-
search, University of California, Santa Barbara). and Byron Reeves, PhD (Depart-
ment of Communication and Human Science, and Technologies [H-STAR] Insti-
tute, Stanford University), for their comments and suggestions. Neither of these
individuals received compensation for their contributions.
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©2011 American Medical Association. All rights reserved.
by guest on April 12, 2011 jama.ama-assn.org Downloaded from