Guidelines for designing effective games as clinical interventions: Mechanics, dynamics, aesthetics, and outcomes (MDAO) framework

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Games are a successful pedagogical tool to change attitudes and behaviors. This chapter will examine how games facilitate change, discuss common pitfalls, and outline best practices for making serious games for clinical practice. Sustained engagement and motivation are key to lasting clinical interventions. When developing a game for clinical practice, the designer should avoid "punishing by rewards" (Kohn, 1993), damaging motivation towards the desired goal. Understanding game design principles is crucial to creating intrinsically engaging experiences that lead to lasting motivation. The Mechanics, Dynamics, and Aesthetics (MDA) framework is widely accepted by game designers as a framework to make compelling games. Using MDA as a base for understanding how to create engaging experiences, this chapter proposes a new framework for serious games called Mechanics, Dynamics, Aesthetics, and Outcomes. MDAO describes how to design a game that is intrinsically motivating and effective by focusing on the interplay between outcomes and other vectors of design.

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... Several studies have analyzed the various elements of game mechanics. For example, Hunicke et al. (2004) indicated that game mechanics usually include achievements, collections, badges etc. Browning (2015) suggested that mechanics are the controls, tools, obstacles, and rules that limit the ways in which users play. Hamzah et al. (2015) proposed that features such as points, levels, leader-boards, virtual goods, badges, gifts, and charity can be considered to be game mechanics. ...
... Aesthetics represent the emotional responses of players to game dynamics. While dynamics help players to achieve the desired outcomes, aesthetics determine the players' engagement with the game (Browning, 2015). Aesthetics are the results of the players' interactions with the game system. ...
... Playfulness illustrates an individual's intrinsic feelings when they are actively engaged in an exercise (Huang and Hsu, 2014). Playfulness is related to the concept of aesthetics that describes players' emotional responses (Browning, 2015). Second, playfulness motivates game system utilization (Chung and Tan, 2004). ...
By adapting Brunswik's lens model and the mechanics, dynamics, and aesthetics (MDA) framework, this study empirically investigated how perceptions of the game features (mechanics), influence game-challenge reactions (dynamics) and playfulness (aesthetics); these influences affected service experience evaluation. The findings revealed that locatability, navigability, and controllability exert positive effects on game-challenge reactions, whereas navigability and nostalgia had positive effects on feelings of playfulness. Furthermore, the relationship between game-challenge reactions and playfulness was determined to be nonrecursive, and both of these factors positively influenced service experience evaluation.
... It is therefore important, as Bohyun (2015) and Robson et al (Robson et al, 2016) put it, that, the perspectives of both the designer and the player be taken into consideration as one develops a game for learning purposes. Browning (2016) takes this argument further by stating that, in designing games for learning purposes, one should consider both the intrinsic motivation and effective engagement of the player or student, by focusing on the interplay between the outcomes and other vectors of the design. ...
... Aesthetical appearance of any activity is likely to spark more interest in engaging with the content. To ensure that students have fun whilst learning, it is imperative the game has elements of excitement, wonder and engagement (Hunicke, et al., 2004;Bohyun, 2015;and Browning, 2016). In this pilot study the game board made use of different coloured spinal vertebrae as blocks with scattered radiographic images throughout the board, see figure 1. ...
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Gamification is used encourage the learner to participate in a competitive activity, to encourage engagement and desire to learn. In the Radiographic Practice module, students learn three core radiography performance standards; professionalism, technique and clinical performance. To address these standards, a pilot radiography board game was developed to determine its effectiveness at improving engagement and interest with learning material and its use as a teaching and learning tool. A qualitative, explorative descriptive research design was used, involving focus group interviews with the radiography students. The students recommended some changes and adjustments on the game design and dynamics. They further described the board game as a fun activity and demonstrated that it was possible to learn whilst engaging with the subject material and group discussions. The board game enabled the students to apply critical thinking skills and be introduced the concept of professionalism in the clinical setting.
... Nevertheless, there have been many critics for the absence of other game dimensions, like narratives. These criticisms lead to several improvement proposals to update the MDA framework, keeping its systemic approach to game design [11]- [13]. The MDA simplicity makes it very useful for game design and game analysis. ...
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Background: Games and elements of gamification can be utilized in mental healthcare to provide customized interventions for the service users. However, very little evidence exists as to what kind of experiences service users and professionals have towards games and gaming, and what their perceptions of the phenomenon are. This sort of information is needed to help professionals put game-based interventions actively into practice in mental health services. Research objectives: The objective is to describe the experiences and perceptions of digital games and gaming from the perspectives of mental health service users and mental health professionals. Methods: In this qualitative study, data consisted of interviews of 23 mental health service users and professionals working in the mental health field. We conducted altogether 39 interviews. Sixteen of the participants were interviewed twice. Main categories and subcategories were identified using qualitative content analysis. Results: The analysis revealed four distinct orientations towards games and gaming: (a) compulsive gaming; (b) closet gaming; (c) gaming as a hobby; and (d) late bloomers. Each group was characterized by different personal histories, experiences, conceptions and attitudes regarding gaming and digital games. Conclusion: When attempting to implement a game-based intervention in mental health services, it is essential to recognize the different attitudes that both service users and staff exhibit concerning games and gaming. The attitudes of service users and professionals described in this study can be utilized in the implementation of game-based methods as part of care and rehabilitation in mental health services.
The purpose of this descriptive qualitative study is to explore the perceptions and experiences that mental health service users (n = 10) and healthcare professionals (n = 32) have regarding the use of gamification in mental health care. Data was gathered by interviews. The mental health service users described promoting and retarding factors in the use of gamification, while professionals described the requirements for using gamification and changes occurring in the work culture. Additional research is needed on how game-playing elements could be integrated as a systematic part of mental health practice and how the digital skills of professionals could be effectively developed.
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There appears to be general agreement among social psychologists that most human behavior is goal-directed (e. g., Heider, 1958 ; Lewin, 1951). Being neither capricious nor frivolous, human social behavior can best be described as following along lines of more or less well-formulated plans. Before attending a concert, for example, a person may extend an invitation to a date, purchase tickets, change into proper attire, call a cab, collect the date, and proceed to the concert hall. Most, if not all, of these activities will have been designed in advance; their execution occurs as the plan unfolds. To be sure, a certain sequence of actions can become so habitual or routine that it is performed almost automatically, as in the case of driving from home to work or playing the piano. Highly developed skills of this kind typically no longer require conscious formulation of a behavioral plan. Nevertheless, at least in general outline, we are normally well aware of the actions required to attain a certain goal. Consider such a relatively routine behavior as typing a letter. When setting this activity as a goal, we anticipate the need to locate a typewriter, insert a sheet of paper, adjust the margins, formulate words and sentences, strike the appropriate keys, and so forth. Some parts of the plan are more routine, and require less conscious thought than others, but without an explicit or implicit plan to guide the required sequence of acts, no letter would get typed.
The advergames represent a new advertising concept that uses Internet technology to implement viral marketing campaigns. Despite the potential of this interactive advertising method, very few academic studies have been initiated to investigate the characteristics of advergames, and their influence on consumers' perceptions and behaviour. This paper attempts to develop a theoretical framework which explains the effect of advergames on players' perceptions and behaviour, and to verify its applicability, using an experimental approach. The research methodology applied combines experiment and surveys; the collected data being analysed and discussed from a quantitative point of view. The results indicate a clear relationship between the exposure to advergames and an increased consumption of the represented brands. The participants experiencing the state of flow are more inclined to increase the frequency of brand purchases, and to communicate with other people about advergames.