Article

A Meta-analysis of Narrative Game-based Interventions for Promoting Healthy Behaviors

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Abstract

Health interventions that use serious games have become increasingly popular. However, many of these games have been designed with few immersive game features which would improve users’ engagement with the persuasive messages. To address this issue, researchers have incorporated narrative elements in games to facilitate message processing and enhance behavioral change. There have been theoretical debates about whether narratives benefit these interventions; empirical evidences for their effects are slightly mixed. This meta-analysis provides a deeper understanding of the overall impact of narrative game-based interventions on health-related behaviors and their psychological determinants. Combining the results from 22 studies, this meta-analysis found that narrative game-based interventions were effective in changing behaviors, knowledge, self-efficacy, and enjoyment. These effects were moderated by factors such as the genre of the game, the genre of the story, group play, and participant age. Implications of the findings and suggestions for future design of narrative game-based interventions were discussed.

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... Research and interventions about HPV vaccinations have adopted several communication technologies such as videos, Facebook pages, SMS text messages, and emails [20], as well as mobile apps [24,25]. However, when communicating with children, preteens, or adolescents specifically, researchers have tested mainly videos and SMS text messages focused on HPV [14,20], despite the fact that several other strategies have been shown to be promising for educating children about health [23,26,27]. For example, serious games and educational animations can encourage adolescents' engagement in health decision-making [26,[28][29][30][31][32][33]. ...
... However, when communicating with children, preteens, or adolescents specifically, researchers have tested mainly videos and SMS text messages focused on HPV [14,20], despite the fact that several other strategies have been shown to be promising for educating children about health [23,26,27]. For example, serious games and educational animations can encourage adolescents' engagement in health decision-making [26,[28][29][30][31][32][33]. Thompson et al [28] developed and assessed a serious videogame about the HPV vaccine for adolescents. ...
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Background Human papillomavirus (HPV) can cause several types of cancers and genital warts. A vaccine is available to prevent HPV infections, and several efforts have been made to increase HPV education and, eventually, vaccination. Although previous studies have focused on the development of messages to educate children about HPV and the existence of the HPV vaccine, limited research is available on how to help children better communicate with their parents and health care professionals about the HPV vaccination. In addition, limited research is available on the target audience of this study (Italian children). Objective This manuscript describes a study assessing the feasibility of using an evidence-based animated video and a web-based game to help children (aged 11-12 years) participate in discussions about their health—in particular when such conversations center around the HPV vaccination—and improve several HPV-related outcomes. The study also compares the effects of these 2 educational multimedia materials on children’s knowledge and perceptions of HPV prevention. Methods A mixed methods approach consisting of focus group discussions and an experiment with children (N=35) was used to understand children’s experiences with, and perceptions of, the animated video and the game and to measure possible improvements resulting from their interaction with these materials. Results Both the animated video and a web-based game increased children’s knowledge and positive perceptions about HPV and HPV vaccination. Any single message was not more effective than the others. The children discussed aspects of the features and characters they liked and those that need improvements. Conclusions This study shows that both materials were effective for improving children’s education about the HPV vaccine and for helping them to feel more comfortable and willing to communicate with their parents and health care professionals about their health. Several elements emerged that will allow further improvements in the design and development of the messages used in this study as well as the creation of future campaigns.
... Research and interventions about HPV vaccinations have adopted several communication technologies such as videos, Facebook pages, SMS text messages, and emails [20], as well as mobile apps [24,25]. However, when communicating with children, preteens, or adolescents specifically, researchers have tested mainly videos and SMS text messages focused on HPV [14,20], despite the fact that several other strategies have been shown to be promising for educating children about health [23,26,27]. For example, serious games and educational animations can encourage adolescents' engagement in health decision-making [26,[28][29][30][31][32][33]. ...
... However, when communicating with children, preteens, or adolescents specifically, researchers have tested mainly videos and SMS text messages focused on HPV [14,20], despite the fact that several other strategies have been shown to be promising for educating children about health [23,26,27]. For example, serious games and educational animations can encourage adolescents' engagement in health decision-making [26,[28][29][30][31][32][33]. Thompson et al [28] developed and assessed a serious videogame about the HPV vaccine for adolescents. ...
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BACKGROUND Human papillomavirus (HPV) can cause several types of cancers and genital warts. A vaccine is available to prevent HPV infections, and several efforts have been made to increase HPV education and, eventually, vaccination. Although previous studies have focused on the development of messages to educate children about HPV and the existence of the HPV vaccine, limited research is available on how to help children better communicate with their parents and health care professionals about the HPV vaccination. In addition, limited research is available on the target audience of this study (Italian children). OBJECTIVE This manuscript describes a study assessing the feasibility of using an evidence-based animated video and a web-based game to help children (aged 11-12 years) participate in discussions about their health—in particular when such conversations center around the HPV vaccination—and improve several HPV-related outcomes. The study also compares the effects of these 2 educational multimedia materials on children’s knowledge and perceptions of HPV prevention. METHODS A mixed methods approach consisting of focus group discussions and an experiment with children (N=35) was used to understand children’s experiences with, and perceptions of, the animated video and the game and to measure possible improvements resulting from their interaction with these materials. RESULTS Both the animated video and a web-based game increased children’s knowledge and positive perceptions about HPV and HPV vaccination. Any single message was not more effective than the others. The children discussed aspects of the features and characters they liked and those that need improvements. CONCLUSIONS This study shows that both materials were effective for improving children’s education about the HPV vaccine and for helping them to feel more comfortable and willing to communicate with their parents and health care professionals about their health. Several elements emerged that will allow further improvements in the design and development of the messages used in this study as well as the creation of future campaigns.
... Furthermore, researchers have attributed the effects of narrative messages to transportation(Gerrig, 2019). van Laer et al.(2014) conducted a meta-analysis of 76 empirical studies on transportation and found significant and persistent effects of transportation on consumers' affect, attention, cognitive elaboration, and behavioral intention across all studies.Transportation demands attention and cognitive resources; thus, people who experience higher levels of transportation are more likely to process, organize, and elaborate on the information at hand, which, in turn, could lead to better memory performance(Whitbred et al., 2010;Zhou et al., 2020). Consistent with this view,Dunlop et al. (2008) found transportation to be positively associated with participants' ad recall. ...
... In a free recall of antismoking ads watched over the previous 2 years, participants who ranked higher on a transportability scale were also found to have higher recall of narrative ads. More recently,Zhou et al. (2020) conducted a metaanalysis of 22 studies (49 effect sizes) to investigate the effectiveness of narrative game-based interventions. They found that games designed based on transportation theory improved gamers' knowledge retention of health-related information. ...
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This study differentiates the roles of telepresence and transportation, the two widely cited processes underpinning an immersive media viewing experience, in the context of virtual marketing. In Study 1, college students viewed a real estate property tour in virtual reality (VR; high immersion) or as a 360° video (low immersion) in a research lab. The tour was accompanied by a voiceover presenting descriptive information about the apartment (descriptive evidence) or a narrative‐based introduction (narrative evidence). We found the enhanced telepresence under the VR viewing condition negatively impacted users' memory of the property; this effect was particularly pronounced with the narrative voiceover. Study 2 replicated key findings from Study 1 in an online experiment with a larger and more diverse sample. We also found that narrative‐induced transportation strengthened attitudinal outcomes, and enhanced telepresence boosted this effect. Our studies disentangle the impacts of VR‐induced telepresence on cognitive processing from the effects of narrative‐induced transportation on persuasive outcomes. The highly immersive media experience combined with deep transportation into the narrative can strengthen viewers' positive attitude towards the overall experience but hinder their ability to remember the details of the content. The findings point to a medium‐message matching strategy to achieve marketing goals.
... Due to its cultural appropriateness, the opportunity to connect to the game played an essential role in ensuring that it was acceptable to parents. Beginning with language (a woman in the game softly narrated in Swahili, Tanzania's official and national language), a safe environment was created for children to feel comfortable with the content [46]. Although CSAPE recommends that children be explicitly taught about healthy and improper interaction by giving proper names to private parts, Tanzanian culture's conservative nature makes it much more suitable to use colloquial words in the game [25,34]. ...
... The storylike game with a narrative flow and basic activities were sufficiently fun for the children to play and help understand lessons while not being too addicting [46]. This feature increased parents' eagerness to encourage their children to play, knowing that they are still going to balance the game's use with other activities. ...
Article
Background: Globally, 3 out of 20 children experience sexual abuse before the age of 18 years. Educating children about sexual abuse and prevention is an evidence-based strategy that is recommended for ending child sexual abuse. Digital games are increasingly being used to influence healthy behaviors in children and could be an efficient and friendly approach to educating children about sexual abuse prevention. However, little is known on the best way to develop a culturally sensitive game that targets children in Africa-where sexual education is still taboo-that would be engaging, effective, and acceptable to parents and caretakers. Objective: This study aimed to develop a socioculturally appropriate, mobile-based game for educating young children (<5 years) and parents and caretakers in Tanzania on sexual abuse prevention. Methods: HappyToto children's game was co-designed with 111 parents and caretakers (females: n=58, 52.3%; male: n=53, 47.7%) of children below 18 years of age and 24 child experts in Tanzania through surveys and focus group discussions conducted from March 2020 to April 2020. From these, we derived an overview of topics, sociocultural practices, social environment, and game interface designs that should be considered when designing child sexual abuse prevention (CSAP) education interventions. We also conducted paper prototyping and storyboarding sessions for the game's interface, storylines, and options. To validate the application's prototype, 32 parents (females: n=18, 56%; males: n=14, 44%) of children aged 3-5 years and 5 children (females: n=2, 40%; males: n=3, 60%) of the same age group played the game for half an hour on average. The parents undertook a pre-post intervention assessment on confidence and ability to engage in CSAP education conversations, as well as exit surveys on the usability and sociocultural acceptability of the game, while children were quizzed on the topics covered and their enjoyment of the game. Results: Parents and caregivers showed interest in the developed game during the conducted surveys, and each parent on average navigated through all the parts of the game. The confidence level of parents in talking about CSAP increased from an average of 3.56 (neutral) before using the game to 4.9 (confident) after using the game. The ability scores, calculated based on a range of topics included in CSAP education talks with children, also increased from 5.67 (out of 10) to 8.8 (out of 10) after the game was played. Both confidence level and ability scores were statistically significant (P<.001). All 5 children were interested in the game and enjoyed the game-provided activities. Conclusions: The HappyToto game can thus be an effective technology-based intervention for improving the knowledge and skills of parents and children in CSAP education.
... The most integrated behavioral change techniques in mobile technology are information, feedback, self-monitoring, goal setting, and social support [13][14][15][16]. Game-based interventions are supported by self-reward and enjoyment [17,18]. For in-home physical exercise training delivered via computer-and internet-based interventions, the main strategies are motivational techniques, communication skills, and goal setting [19]. ...
... Second, in accordance with our hypothesis, the results showed that high scores on control orientation predicted a high acceptability active video games profile. This is consistent with the observation that game-based interventions usually include rewards [17,18,58]. Third, another major result was that high scores on control orientation and low scores on impersonal orientation predicted a high acceptability mobile applications profile. ...
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Objectives This study aimed to: (a) identify the acceptability profiles for three technology-based physical activity interventions (TbPAI) in obesity treatment (active video games, mobile applications, telehealth), (b) examine the issues of consistency or change in these profiles for the same individual across technologies, and (c) determine whether acceptability profiles are related to motivational factors. Methods Three hundred and twelve women (Mage = 30.7, SD = 7.1 years; MBMI = 34.5, SD = 7.8 kg/m²) using obesity services were recruited for this cross-sectional survey. They completed an online survey including sociodemographic data and measures related to physical activity: level, stage of change, motivation, and general causality orientations. The women read descriptions of the three technologies and rated their acceptability. We used a latent profile transition analysis (LPTA) approach. Results A 2-class model (high and low acceptability) best described the profiles for each technology. Intra-individual analysis revealed that the profiles exhibited both changes and stability across TbPAI. Women with high scores on impersonal orientation were more likely to be in the high acceptability telehealth profile, whereas those reporting high scores on control orientation were more likely to be in the high acceptability active video games profile. Women with high scores on control orientation and low scores on impersonal orientation were more likely to be in the high acceptability mobile applications profile. Conclusions Results showed that the causality orientations were factors related to the TbPAI acceptability profiles, suggesting that clinicians should consider these psychological characteristics in TbPAI counseling.
... When the user feels transported into the narrative event and identifies with the characters, there will be a higher level of readiness to accept the health message embedded in the narrative [32]. Narrative-based health games were indeed perceived as more enjoyable [33]. ...
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Physical activity interventions for youth are direly needed given low adherence to physical activity guidelines, but many interventions suffer from low user engagement. Exergames that require bodily movement while played may provide an engaging form of physical activity intervention but are not perceived as engaging to all. This study aimed to evaluate whether dynamic tailoring in a narrative-driven mobile exergame for adolescents played in leisure settings, can create higher user engagement compared to a non-tailored exergame. A cluster-randomized controlled trial assessed differences in user engagement between a dynamically tailored (based on an accelerometer sensor integrated in a T-shirt) and non-tailored condition. In total, 94 participants (M age = 14.61 ± 0.1.93; 35% female) participated and were assigned to one of the two conditions. User engagement was measured via a survey and game metric data. User engagement was low in both conditions. Narrative sensation was higher in the dynamically tailored condition, but the non-tailored condition showed longer play-time. User suggestions to create a more appealing game included simple and more colorful graphics, avoiding technical problems, more variety and shorter missions and multiplayer options. Less cumbersome or more attractive sensing options than the smart T-shirt may offer a more engaging solution, to be tested in future research.
... Focusing more on the narratives in a game can help to improve users' appreciation of the game and shape their behaviour (Zhou et al. 2020;Qin, Rau, and Salvendy 2010). Users' full dedications to the narratives in the mobile fitness Apps can enhance the impacts of fitness-related cues and virtual goals in the App that eventually strengthen their real-world fitness purpose. ...
Article
Many users fail to stick to the use of mobile fitness apps. As a key element of gamification mechanisms, effective gamification narrative design has the potential to draw the users in and motivates them to develop stronger motivations to achieve their real-world goals and higher persistent usage intentions of the mobile fitness App. Underpinned by goal priming theory, we conducted two controlled experiments, surrounding core aspects of gamification narrative design, namely narrative path agility and narrative target clarity. The results, which revealed that different forms of gamification narrative design impact users’ real-world fitness purpose and persistent usage intentions through different strategies, provide interesting implications for both theory and practice.
... As young women may be turning to social media when bored, including prevention efforts that entertain while also educating may help by first garnering attention, which can be difficult in the crowded social media environment. A recent meta-analysis of narrative game-based health behavior interventions found that such interventions had a large effect on improving knowledge, a medium effect on self-efficacy, and small effects on increasing enjoyment and encouraging health behaviors [65]. Narrative game-based interventions provided through or promoted on social media could be a useful option to explore for tanning prevention efforts. ...
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Background Research has pointed to a connection between social media use, emotions, and tanning behaviors. However, less is known about the role specific emotions may play in influencing social media use and how emotions and social media use may each be associated with outdoor tanning. Objective This paper aims to examine the connection between emotions, social media use, and outdoor tanning behaviors among young women, a group particularly important for skin cancer prevention efforts. Methods We used ecological momentary assessment to collect data from 197 women aged 18 to 25 years 3 times a day for 7 days in July 2018. We collected data from women in 2 states. Results We found that boredom was associated with increased time spent on social media and that increased time spent on social media was associated with increased time spent outdoors without sun protection. Conclusions Our results highlight that social media may be a particularly important channel for skin cancer prevention efforts targeting young women, as more social media use was associated with increased time spent outdoors with skin exposed. Researchers should consider the role of emotions in motivating social media use and subsequent tanning behaviors. Additionally, as boredom was associated with social media use, intervention developers would benefit from developing digital and social media interventions that entertain as well as educate.
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Games have the potential to not only entertain and immerse people, but can be used as vehicles for meaning-making. Given these qualities, games are approached as inspiration for caring technologies, especially for mental health. This transformative process often prioritises learning from games as systems, but not necessarily from the experiences of people with mental distress who play games for self-care. In this paper, we report on a participatory workshop series that sets out to further illuminate the connection between games, self-care and mental health from a humanistic, person-centred perspective. Over four workshops, we engaged 16 people with experiences of mental distress in speculative making activities and discussions of how self-care technology inspired by games could be re-envisioned. By thematically analysing our discussions and collective sense-making, we showcase how participants actively "re-frame" games for self-care. Finally, we sketch out how game developers and makers of gameful self-care technologies could build on our findings.
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Despite increasing scientific interest in explaining how gamification supports positive affect and motivation, behavior change and learning, there is still a lack of an overview of the current theoretical understanding of the psychological mechanisms of gamification. Previous research has adopted several different angles and remains fragmented. Taking both an observational and explanatory perspective, we examined the theoretical foundations used in research on gamification, serious games and game-based learning through a systematic literature review and then discussed the commonalities of their core assumptions. The overview shows that scientists have used a variety of 118 different theories. Most of them share explicitly formulated or conceptual connections. From their interrelations, we derived basic principles that help explain how gamification works: Gamification can illustrate goals and their relevance, nudge users through guided paths, give users immediate feedback, reinforce good performance and simplify content to manageable tasks. Gamification mechanics can allow users to pursue individual goals and choose between different progress paths, while the system can adapt complexity to the user's abilities. Social gamification elements may enable social comparison and connect users to support each other and work towards a common goal.
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Trauma triage depends on fallible human judgment. We created two "serious" video game training interventions to improve that judgment. The interventions' central theoretical construct was the representativeness heuristic, which, in trauma triage, would mean judging the severity of an injury by how well it captures (or "represents") the key features of archetypes of cases requiring transfer to a trauma center. Drawing on clinical experience, medical records, and an expert panel, we identified features characteristic of representative and nonrepresentative cases. The two interventions instantiated both kinds of cases. One was an adventure game, seeking narrative engagement; the second was a puzzle-based game, emphasizing analogical reasoning. Both incorporated feedback on diagnostic errors, explaining their sources and consequences. In a four-arm study, they were compared with an intervention using traditional text-based continuing medical education materials (active control) and a no-intervention (passive control) condition. A sample of 320 physicians working at nontrauma centers in the United States was recruited and randomized to a study arm. The primary outcome was performance on a validated virtual simulation, measured as the proportion of undertriaged patients, defined as ones who had severe injuries (according to American College of Surgeons guidelines) but were not transferred. Compared with the control group, physicians exposed to either game undertriaged fewer such patients [difference = -18%, 95% CI: -30 to -6%, P = 0.002 (adventure game); -17%, 95% CI: -28 to -6%, P = 0.003 (puzzle game)]; those exposed to the text-based education undertriaged similar proportions (difference = +8%, 95% CI: -3 to +19%, P = 0.15).
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Physically active video games (AVGs) have been found to positively impact physical activity behaviors, especially when a narrative is added. However, the motivational and cognitive benefits of adding narrative to AVG are unclear. We examined the separate and additive effects of narrative and AVG on physical activity and cognitive function versus an active comparator, such as a sedentary video game (SVG). We randomly assigned young adults to one of four groups (narrative-AVG, AVG, narrative-SVG, or SVG) and had them complete sustained attention and working memory tasks before and after a 30-min experimental condition. Participants in both narrative-AVG and AVG groups achieved a moderate-intensity physical activity, while adding narrative to AVG resulted in higher step counts and more time spent in moderate-to-vigorous physical activity than AVG without narrative. Regardless of the narrative effect, participants in both AVG groups performed better on overall working memory than both SVG groups, while both AVG and SVG groups similarly achieved maximal performance in sustained attention. Working memory enhancement was positively correlated with increased heart rate. Participants in narrative-SVG group had a better response accuracy in working memory than those who played SVG without narrative. Taken together, adding narrative to AVG as a motivational component increased physical activity, which was the primary factor in the improvement of overall working memory.
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Background: There is a pressing need to ensure that youth in high HIV prevalence settings are prepared for a safer sexual debut. Smartphone ownership is increasing dramatically in low-income and middle-income countries. Smartphone games that are appropriately grounded in behavioral theory and evidence-based practice have the potential to become valuable tools in youth HIV prevention efforts in Sub-Saharan Africa. Objective: To pilot-test a theory-based, empirically grounded smartphone game for young Kenyans designed to increase age and condom use at first sex, aiming to establish directionality of effects on behavior change. Methods: Tumaini (“hope for the future” in Swahili) is an interactive, narrative-based game grounded in social cognitive theory. A randomized controlled pilot study was conducted in Kisumu, Western Kenya, from April to June 2017 with 60 participants aged 11-14 (mean 12.7) years. Intervention arm participants (n=30) were provided with an Android smartphone with Tumaini installed on it and were instructed to play the game for at least 1 hour a day for 16 days; control arm participants (n=30) received no intervention. All participants completed a survey on behavioral mediators, delivered via an audio computer-assisted self-interview system at baseline (T1), post intervention (T2), and at 6 weeks postintervention (T3). The postintervention survey for intervention arm participants included questions eliciting feedback on the game. Intervention arm participants and their parents participated in 8 postintervention focus group discussions. Game log files were analyzed to calculate the length of exposure to the game. Behavioral survey data were analyzed using two-sample t tests to compare mean change from T1 to T2 and to T3 for intervention versus control arm participants. Descriptive statistics on game feedback questions were computed. Focus group transcripts were uploaded to MAXQDA software, where they were labeled with deductive and inductive codes. Data were analyzed thematically and compared across demographics. Results: Intervention arm participants played Tumaini for a mean of approximately 27 hours. The intervention arm showed significant gains in sexual health-related knowledge and self-efficacy (both P<.001), behavioral intention for risk-avoidance strategies and sexual risk communication (P=.006), and overall survey scores (P<.001) compared with the control arm at T3. The postintervention survey revealed high subjective measures of the game’s value, relevance, and appeal. Focus groups identified a wide range of knowledge and skills the participants had gained, including setting goals and planning how to achieve them, which was perceived as a key motivator for avoiding or reducing risk. Conclusions: The study supports the need for further research to assess the efficacy of the game-based intervention. If proven efficacious, smartphone games have the potential to dramatically increase the reach of culturally adapted behavioral interventions while ensuring fidelity to intervention design. © Kate Winskell, Gaëlle Sabben, Victor Akelo, Ken Ondeng'e, Christopher Obong'o, Rob Stephenson, David Warhol, Victor Mudhune.
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Objective To determine whether a behavioral intervention delivered through a video game can improve the appropriateness of trauma triage decisions in the emergency department of non-trauma centers. Design Randomized clinical trial. Setting Online intervention in national sample of emergency medicine physicians who make triage decisions at US hospitals. Participants 368 emergency medicine physicians primarily working at non-trauma centers. A random sample (n=200) of those with primary outcome data was reassessed at six months. Interventions Physicians were randomized in a 1:1 ratio to one hour of exposure to an adventure video game (Night Shift) or apps based on traditional didactic education (myATLS and Trauma Life Support MCQ Review), both on iPads. Night Shift was developed to recalibrate the process of using pattern recognition to recognize moderate-severe injuries (representativeness heuristics) through the use of stories to promote behavior change (narrative engagement). Physicians were randomized with a 2×2 factorial design to intervention (game v traditional education apps) and then to the experimental condition under which they completed the outcome assessment tool (low v high cognitive load). Blinding could not be maintained after allocation but group assignment was masked during the analysis phase. Main outcome measures Outcomes of a virtual simulation that included 10 cases; in four of these the patients had severe injuries. Participants completed the simulation within four weeks of their intervention. Decisions to admit, discharge, or transfer were measured. The proportion of patients under-triaged (patients with severe injuries not transferred to a trauma center) was calculated then (primary outcome) and again six months later, with a different set of cases (primary outcome of follow-up study). The secondary outcome was effect of cognitive load on under-triage. Results 149 (81%) physicians in the game arm and 148 (80%) in the traditional education arm completed the trial. Of these, 64/100 (64%) and 58/100 (58%), respectively, completed reassessment at six months. The mean age was 40 (SD 8.9), 283 (96%) were trained in emergency medicine, and 207 (70%) were ATLS (advanced trauma life support) certified. Physicians exposed to the game under-triaged fewer severely injured patients than those exposed to didactic education (316/596 (0.53) v 377/592 (0.64), estimated difference 0.11, 95% confidence interval 0.05 to 0.16; P<0.001). Cognitive load did not influence under-triage (161/308 (0.53) v 155/288 (0.54) in the game arm; 197/300 (0.66) v 180/292 (0.62) in the traditional educational apps arm; P=0.66). At six months, physicians exposed to the game remained less likely to under-triage patients (146/256 (0.57) v 172/232 (0.74), estimated difference 0.17, 0.09 to 0.25; P<0.001). No physician reported side effects. The sample might not reflect all emergency medicine physicians, and a small set of cases was used to assess performance. Conclusions Compared with apps based on traditional didactic education, exposure of physicians to a theoretically grounded video game improved triage decision making in a validated virtual simulation. Though the observed effect was large, the wide confidence intervals include the possibility of a small benefit, and the real world efficacy of this intervention remains uncertain. Trial registration clinicaltrials.gov; NCT02857348 (initial study)/NCT03138304 (follow-up).
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Background: Having health insurance is associated with a number of beneficial health outcomes. However, previous research suggests that patients tend to avoid health insurance information and often misunderstand or lack knowledge about many health insurance terms. Health insurance knowledge is particularly low among young adults. Objective: The purpose of this study was to design and test an interactive newsgame (newsgames are games that apply journalistic principles in their creation, for example, gathering stories to immerse the player in narratives) about health insurance. This game included entry-level information through scenarios and was designed through the collation of national news stories, local personal accounts, and health insurance company information. Methods: A total of 72 (N=72) participants completed in-person, individual gaming sessions. Participants completed a survey before and after game play. Results: Participants indicated a greater self-reported understanding of how to use health insurance from pre- (mean=3.38, SD=0.98) to postgame play (mean=3.76, SD=0.76); t71=-3.56, P=.001. For all health insurance terms, participants self-reported a greater understanding following game play. Finally, participants provided a greater number of correct definitions for terms after playing the game, (mean=3.91, SD=2.15) than they did before game play (mean=2.59, SD=1.68); t31=-3.61, P=.001. Significant differences from pre- to postgame play differed by health insurance term. Conclusions: A game is a practical solution to a difficult health issue-the game can be played anywhere, including on a mobile device, is interactive and will thus engage an apathetic audience, and is cost-efficient in its execution.
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Cognitive flexibility, the ability to flexibly switch between tasks, is a core dimension of executive functions (EFs) allowing to control actions and to adapt flexibly to changing environments. It supports the management of multiple tasks, the development of novel, adaptive behavior and is associated with various life outcomes. Cognitive flexibility develops rapidly in preschool and continuously increases well into adolescence, mirroring the growth of neural networks involving the prefrontal cortex. Over the past decade, there has been increasing interest in interventions designed to improve cognitive flexibility in children in order to support the many developmental outcomes associated with cognitive flexibility. This article provides a brief review of the development and plasticity of cognitive flexibility across early and middle childhood (i.e., from preschool to elementary school age). Focusing on interventions designed to improve cognitive flexibility in typically developing children, we report evidence for significant training and transfer effects while acknowledging that current findings on transfer are heterogeneous. Finally, we introduce metacognitive training as a promising new approach to promote cognitive flexibility and to support transfer of training.
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Although narratives are often credited with the capacity to change opinions, empirical tests of this prediction have produced mixed results. To provide a more precise test of narrative's effect on beliefs, attitudes, intentions, and behaviors, we performed meta-analyses on studies that evaluated narrative's persuasive influence on these outcomes. Results suggested positive relationships between exposure to a narrative and narrative-consistent beliefs (k = 37; N = 7,376; r = .17), attitudes (k = 40; N = 7,132; r = .19), intentions (k = 28; N = 5,211; r = .17), and behaviors (k = 5; N = 978; r = .23). Moderator analyses on the effect of fictionality yielded mixed results. Neither medium of presentation nor research design influenced the magnitude of the narrative-persuasion relationship. However, results suggested the presence of unidentified moderators.
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Background Active video games (AVGs) capable of inducing physical activity offer an innovative approach to combating childhood obesity. Unfortunately, children’s AVG game play decreases quickly, underscoring the need to identify novel methods for player engagement. Narratives have been demonstrated to influence behaviors. Objective The objective of this study was to test the hypothesis that a narrative would motivate increased AVG play, though a feasibility study that investigated the motivational effect of adding a previously developed narrative cutscene to an originally nonnarrative AVG, Nintendo Wii Sports Resort: Swordplay Showdown. Methods A total of 40 overweight and obese 8- to 11-year-olds equally divided by sex played the AVG. Half (n=20) were randomly assigned to a narrative group that watched the narrative cutscene before game play. The other half played the game without watching it. Results Children in the narrative group had significantly (P<.05) more steps per 10-second period (mean 3.2, SD 0.7) and overall (mean 523, SD 203) during game play compared with the nonnarrative group (10-second period: mean 2.7, SD 0.7; overall: mean 366, SD 172). Conclusions The AVG with narrative induced increased physical activity. Additional research is needed to understand the mechanisms through which narrative increases physical activity during AVG game play.
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p> BACKGROUND & AIM : Patient right compliance plays a crucial role to improve and set the relationship between providers and clients in health system. Thus, it is very essential in health system management. This study aimed to determine Patient right bill observance rate in training hospitals affiliated to Ahvaz Jundishapur University of Medical Sciences from nurses’ point of view. METHOD : This was a descriptive-analytical and cross-sectional study. The research population included all nurses who worked at training hospitals of Ahvaz Jundishapur University of Medical Sciences. Sample size calculated 90. Sampling conducted randomly with proper distribution. The study tool was a questionnaire with two parts: demographic and patient right observance related questions. RESULTS : Patient right observance score was 3.02±0.57 and estimated relatively appropriate. The proper and safe health care, awareness and choosing the proper services rights components with scores less than 3 were estimated relatively weak. Secrecy and privacy and the right of objection components’ scores calculated between 3 and 4 so estimated relatively appropriate. Age, job, marital status and experience groups showed no significant difference in scores of patient right observance. CONCLUSION : The patient rights were not completely deliberated in hospitals from view point of nurses. In order to developing this condition, more commitment in setting the rights of proper and safe health care, awareness and choosing the proper services seems necessary.</p
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Videogames for health (G4H) offer exciting, innovative, potentially highly effective methods for increasing knowledge, delivering persuasive messages, changing behaviors, and influencing health outcomes. Although early outcome results are promising, additional research is needed to determine the game design and behavior change procedures that best promote G4H effectiveness and to identify and minimize possible adverse effects. Guidelines for ideal use of different types of G4H by children and adolescents should be elucidated to enhance effectiveness and minimize adverse effects. G4H stakeholders include organizational implementers, policy makers, players and their families, researchers, designers, retailers, and publishers. All stakeholders should be involved in G4H development and have a voice in setting goals to capitalize on their insights to enhance effectiveness and use of the game. In the future, multiple targeted G4H should be available to meet a population’s diverse health needs in developmentally appropriate ways. Substantial, consistent, and sophisticated research with appropriate levels of funding is needed to realize the benefits of G4H.
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Physical activity is a modifiable behavior related to many preventable non-communicable diseases. There is an age-related decline in physical activity levels in young people, which tracks into adulthood. Common interactive technologies such as smartphones, particularly employing immersive features, may enhance the appeal and delivery of interventions to increase levels of physical activity in young people. The primary aim of the Apps for IMproving FITness (AIMFIT) trial is to evaluate the effectiveness of two popular "off-the-shelf" smartphone apps for improving cardiorespiratory fitness in young people. A three-arm, parallel, randomized controlled trial will be conducted in Auckland, New Zealand. Fifty-one eligible young people aged 14-17 years will be randomized to one of three conditions: 1) use of an immersive smartphone app, 2) use of a non-immersive app, or 3) usual behavior (control). Both smartphone apps consist of an eight-week training program designed to improve fitness and ability to run 5 km, however, the immersive app features a game-themed design and adds a narrative. Data are collected at baseline and 8 weeks. The primary outcome is cardiorespiratory fitness, assessed as time to complete the one mile run/walk test at 8 weeks. Secondary outcomes are physical activity levels, self-efficacy, enjoyment, psychological need satisfaction, and acceptability and usability of the apps. Analysis using intention to treat principles will be performed using regression models. Despite the proliferation of commercially available smartphone applications, there is a dearth of empirical evidence to support their effectiveness on the targeted health behavior. This pragmatic study will determine the effectiveness of two popular "off-the-shelf" apps as a stand-alone instrument for improving fitness and physical activity among young people. Adherence to app use will not be closely controlled; however, random allocation of participants, a heterogeneous group, and data analysis using intention to treat principles provide internal and external validity to the study. The primary outcome will be objectively assessed with a valid and reliable field-based test, as well as the secondary outcome of physical activity, via accelerometry. If effective, such applications could be used alongside existing interventions to promote fitness and physical activity in this population. Australian New Zealand Clinical Trials Registry: ACTRN12613001030763 . Registered 16 September 2013.
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Individuals with disabilities experience more negative outcomes due to natural and manmade disasters and emergencies than do people without disabilities. This vulnerability appears to be due in part to knowledge gaps among public health and safety emergency planning and response personnel (responders). We assessed the effectiveness of an online program to increase emergency responder knowledge about emergency planning and response for individuals with disabilities. Researchers developed an online course designed to teach public health, emergency planning and management, and other first response personnel about appropriate, efficient, and equitable emergency planning, response, interaction, and communication with children and adults with disabilities before, during, and after disasters or emergencies. Course features included an ongoing storyline, exercises embedded in the form of real-life scenarios, and game-like features such as points and timed segments. Evaluation measures indicated significant pre- to post-test gains in learner knowledge and simulated applied skills. An online program using scenarios and simulations is an effective way to make disability-related training available to a wide variety of emergency responders across geographically disparate areas. (Disaster Med Public Health Preparedness. 2014;8:533-540).
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Sexual assault is prevalent among college students. In response, universities have implemented prevention education initiatives. These interventions, however, often ignore the broader sociocultural context in which sexual violence occurs. This calls for innovative approaches in prevention education, which address the broader context. Computer games provide such an opportunity by providing simulated real-life scenarios, nonlinear narratives, and an interactive medium. We report the development and pilot testing of "Campus Craft," a game prototype that focuses, among other things, on sexual assault prevention. The prototype was developed through a participatory design process; students, educators, and subject matter experts helped design and develop scenarios, game mechanics, and learning objectives. The prototype was evaluated by college students (n=141) in a multi-method approach. The evaluation encompassed issues of usability, game mechanics, attitudes, and learning outcomes. Findings indicated that participants rated various aspects of the game positively. Additionally, use of "Campus Craft" contributed to differences in student learning of prevention concepts between the pre- and post-test such that students scored higher on the post-test. Findings demonstrate that, on average, students learned several core concepts related to sexual consent and rape culture through gameplay. Results suggest that computer-based gaming may be a viable avenue for sexual assault prevention education. Findings demonstrate that this approach could be effective in increasing student knowledge and understanding of factors that contribute to sexual assault in college. Future research is needed to corroborate findings and better understand the feasibility of using this approach among larger samples of college students.
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Serious games may be effective in promoting sexual health behavior. Their confidential nature may encourage users to discuss sensitive sexuality topics. Furthermore, they can tailor messages to the individual's needs and may be intrinsically motivating. This meta-analysis investigates the effectiveness of interventions for sexual health promotion that use serious games. A database search was conducted in PubMed, Web of Science, CINAHL, and PsycINFO for publications before the end of July 2013. Serious digital games studies measuring effects on behavior or its determinants, using a control condition, allowing the calculation of an effect size (Hedges' g, random-effects model) were included. Seven game studies for sexual health promotion were included. These showed positive effects on determinants (g=0.242; 95 percent confidence interval, 0.129, 0.356), albeit of small effect size. The effects on behavior, measured in only two studies, were not significant (g=0.456; 95 percent confidence interval, -0.649, 1.561). Most games did not use many game features that are considered to be immersive or enhancing flow. Instead, there was a strong reliance on pure gamification features, such as rewards and feedback. The effectiveness of the next generation of games may be enhanced by building on the behavioral change and educational gaming literatures (e.g., using role-play and simulation game formats, individual tailoring, offering adaptation in the difficulty of the challenge, and amount and timing of the feedback). There is a need for studies with rigorous evaluations of game effectiveness, longer-term follow-up, and using measures of behavior rather than merely their determinants.
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Having diverse faculty in academic health centers will help diversify the healthcare workforce and reduce health disparities. Implicit race bias is one factor that contributes to the underrepresentation of Black faculty. We designed the videogame "Fair Play" in which players assume the role of a Black graduate student named Jamal Davis. As Jamal, players experience subtle race bias while completing "quests" to obtain a science degree. We hypothesized that participants randomly assigned to play the game would have greater empathy for Jamal and lower implicit race bias than participants randomized to read narrative text describing Jamal's experience. University of Wisconsin-Madison graduate students were recruited via e-mail and randomly assigned to play "Fair Play" or read narrative text through an online link. Upon completion, participants took an Implicit Association Test to measure implicit bias and answered survey questions assessing empathy toward Jamal and awareness of bias. As hypothesized, gameplayers showed the least implicit bias but only when they also showed high empathy for Jamal (P=0.013). Gameplayers did not show greater empathy than text readers, and women in the text condition reported the greatest empathy for Jamal (P=0.008). However, high empathy only predicted lower levels of implicit bias among those who actively took Jamal's perspective through gameplay (P=0.014). A videogame in which players experience subtle race bias as a Black graduate student has the potential to reduce implicit bias, possibly because of a game's ability to foster empathy through active perspective taking.
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Introduction: A serious game is an application that combines ‘serious’ goals (pedagogical, informational, communicational, ideological, or training) with ‘ludic’ aims stemming from video games for example. Digital images and games associated in serious games become devices making sense in the context of organization communication. Objectives: The field of serious games enables researchers to understand communication practices in organizations and in particular the bodily features and rituals that occur in the course of the games. Methods: The empirical research presented in this paper addresses the scientific issue of games appropriation and its effects on organization.The study is based on a serious game that was designed in order to train managers for evaluation interviews. It was put into practice with five health managers at a Hospital in Annecy (Rhône-Alpes - France). Conclusions: The serious game was not ‘immersive’ enough. The managers could transpose and transfer for use in their real life interview situation.
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There has been a debate about whether entertainment videogames should incorporate story or narrative. A concern has been whether story cut scenes break game immersion, and thereby minimize the fun of gameplay. Alternatively, games for health (G4H) have an agenda that goes beyond just having fun. The possible role of story in G4H has not been thoroughly addressed. We have assembled a group of experts who have worked with stories in G4H, and asked some pointed questions.
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Stories can serve as powerful tools for health interventions. Story immersion refers to the experience of being absorbed in a story. This is among the first studies to analyze story immersion's role in health videogames among children by addressing two main questions: Will children be more immersed when the main characters are similar to them? Do increased levels of immersion relate to more positive health outcomes? Eighty-seven 10-12-year-old African-American, Caucasian, and Hispanic children from Houston, TX, played a health videogame, "Escape from Diab" (Archimage, Houston, TX), featuring a protagonist with both African-American and Hispanic phenotypic features. Children's demographic information, immersion, and health outcomes (i.e., preference, motivation, and self-efficacy) were recorded and then correlated and analyzed. African-American and Hispanic participants reported higher immersion scores than Caucasian participants (P = 0.01). Story immersion correlated positively (P values < 0.03) with an increase in Fruit and Vegetable Preference (r = 0.27), Intrinsic Motivation for Water (r = 0.29), Vegetable Self-Efficacy (r = 0.24), and Physical Activity Self-Efficacy (r = 0.32). Ethnic similarity between videogame characters and players enhanced immersion and several health outcomes. Effectively embedding characters with similar phenotypic features to the target population in interactive health videogame narratives may be important when motivating children to adopt obesity prevention behaviors.
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To provide a causal test of identification as a mechanism of narrative persuasion, this study uses the perspective from which a story is told to manipulate identification experimentally and test effects on attitudes. In experiment 1, 120 participants read a story that was told either from the perspective of one character or another character, with both characters having opposing goals. Results showed that perspective influenced identification and story consistency of attitudes. Moreover, identification with one of the characters mediated the effect of perspective on attitudes. In experiment 2, 200 participants read a different story that was told from one of two perspectives, with both characters having opposing opinions. Results showed that identification with both characters mediated the effect of perspective on attitudes. The results of these experiments indicate that identification can be a mechanism of narrative persuasion.
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Empirical studies have validated that basic needs satisfaction supported by video game play predicts motivation and engagement outcomes. However, few studies specifically manipulated game features for each of the three basic needs specified in the self-determination theory (SDT) to examine how the game features impact players' need satisfaction and game experience. The current study employed an in-house developed exergame and manipulated the game features in a 2 (autonomy-supportive game features: on vs. off) × 2 (competence-supportive game features: on vs. off) experiment to predict need satisfaction, game enjoyment, motivation for future play, effort for gameplay, self-efficacy for exercise using the game, likelihood of game recommendation, and game rating. The manipulated game features led to the corresponding need satisfaction. Manipulated autonomy-supportive and competence-supportive game features had main effects on most motivation and engagement outcomes. Need satisfaction of autonomy and need satisfaction of competence were both found to be mediators for the relationships between the game features and the motivation and engagement outcomes. The findings add evidence to support the underlying mechanism postulated by SDT for media enjoyment and motivation as well as the emerging entertainment research conceptualizing enjoyment as need satisfaction. The findings also have practical implications for intervention effort that intends to capitalize the motivational pull of video games.
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Four studies apply self-determination theory (SDT; Ryan & Deci, 2000) in investigating motivation for computer game play, and the effects of game play on well-being. Studies 1–3 examine individuals playing 1, 2 and 4 games, respectively and show that perceived in-game autonomy and competence are associated with game enjoyment, preferences, and changes in well-being pre- to post-play. Competence and autonomy perceptions are also related to the intuitive nature of game controls, and the sense of presence or immersion in participants’ game play experiences. Study 4 surveys an on-line community with experience in multi-player games. Results show that SDT’s theorized needs for autonomy, competence, and relatedness independently predict enjoyment and future game play. The SDT model is also compared with Yee’s (2005) motivation taxonomy of game play motivations. Results are discussed in terms of the relatively unexplored landscape of human motivation within virtual worlds.
Article
Objective: The aim of this study was to investigate which narrative elements of digital game narratives are preferred by the general adolescent population, and to examine associations with gender, socioeconomic status (SES), and gameplay frequency. Further, the study aims to discuss how results can be translated to serious digital games. Materials and Methods: Adolescents were recruited through school to complete a survey on narrative preferences in digital games. The survey included questions on sociodemographic information, frequency of gameplay, and an open-ended question on what could be an appealing narrative for them. Data were analyzed in a mixed-methods approach, using thematic analysis and chi-square analyses to determine narrative preferences and the associations between game narrative elements and player characteristics (gender, SES, and frequency of gameplay). Results: The sample consisted of 446 adolescents (12–15 years old) who described 30 narrative subthemes. Preferences included human characters as protagonists; nonhuman characters only as antagonists; realistic settings, such as public places or cities; and a strong conflict surrounding crime, catastrophe, or war. Girls more often than boys defined characters by their age, included avatars, located the narrative in private places, developed profession-related skills, and included a positive atmosphere. Adolescents of nonacademic education more often than adolescents of academic education defined characters by criminal actions. Infrequent players more often included human characters defined by their age than frequent players. After performing a Bonferroni correction, narrative preferences for several gender differences remained. Conclusion: Different narrative elements related to subgroups of adolescents by gender, SES, and frequency of gameplay. Customization of narratives in serious digital health games should be warranted for boys and girls; yet, further research is needed to specify how to address girls in particular.
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The benefits of a healthy lifestyle during childhood are difficult to overestimate and computer games represent a promising intervention to promote healthy lifestyles in children. The purpose of this pilot study was to examine the effects of online games for improving children’s knowledge of healthy nutrition and physical activity (PA) guidelines. Using an experimental design, we aimed to understand if children aged 7-9 liked this type of intervention, if baseline knowledge of PA or nutrition guidelines improved after playing one of two games, and beyond those of the control condition, and if one game was more effective than the other. Each intervention, including the control, resulted in positive change, showing an overall improved knowledge. The game with the greatest improvements was the more interactive game that gave feedback along the way. Our pilot study showed that games may be useful in promoting healthy lifestyles to children. Full text available here: http://www.ccsenet.org/journal/index.php/gjhs/article/view/65519/36189
Article
Objective: To evaluate the effect of playing a health video game embedded with story immersion, Escape from Diab (Diab), on children's diet and physical activity (PA) and to explore whether children immersed in Diab had greater positive outcomes. Design: Two groups, nonrandomized; 3 outcome assessments: at baseline, immediately after the game (post 1), and 8-10 weeks after the game (post 2). Participants: A total of 179 Chinese children aged 8-12 years. Intervention: The treatment group played Diab; the control group received no intervention. Main outcome measures: Motivation; self-efficacy; preference for fruit, vegetables, water, and PA; as well as PA behavior. Analysis: Adjusted changes to post 1 and post 2 by ANCOVA controlling for demographic and baseline variables. Results: Children who played Diab had increased intrinsic motivation for fruit and water, self-efficacy for PA, and self-reported PA scores at post 1 (all P < .05). Children with higher immersion scores (above the median) had increased intrinsic motivation for fruit and water, and autonomous and controlled motivation for PA at post 1 (all P < .05). However, these were not significant at post 2. Conclusions and implications: Diab provides a promising innovative medium for promoting Chinese children's psychological correlates of diet and PA and PA behavior. However, its maintenance of effectiveness needs to be enhanced and mechanisms of change need to be investigated more thoroughly.
Article
Objective: Previously published versions of the healthy eating "FIT Game" were administered by teachers in all grades at elementary schools. The present study evaluated whether the game would retain its efficacy if teachers were relieved of this task; presenting instead all game materials on visual displays in the school cafeteria. Materials and methods: Participants were 572 children attending two Title 1 elementary schools (grades K-5). Following a no-intervention baseline period in which fruit and vegetable consumption were measured from food waste, the schools played the FIT Game. In the game, the children's vegetable consumption influenced events in a good versus evil narrative presented in comic book-formatted episodes in the school cafeteria. When daily vegetable-consumption goals were met, new FIT Game episodes were displayed. Game elements included a game narrative, competition, virtual currency, and limited player autonomy. The two intervention phases were separated by a second baseline phase (within-school reversal design). Simulation Modeling Analysis (a bootstrapping technique appropriate to within-group time-series designs) was used to evaluate whether vegetable consumption increased significantly above baseline levels in the FIT Game phases (P?<?0.05). Results: Vegetable consumption increased significantly from 21.3?g during the two baseline phases to 42.5?g during the FIT Game phases; a 99.9% increase. The Game did not significantly increase fruit consumption (which was not targeted for change), nor was there a decrease in fruit consumption. Conclusion: Labor-reductions in the FIT Game did not reduce its positive impact on healthy eating.
Chapter
This chapter covers the topic of multiplayer serious games. Multiplayer games are discussed in terms of game types and forms, genres and techniques, as well as their impact on the use of multiplayer games. Based on that, this chapter will show how different types of multiplayer genres and techniques can be used for various serious game purposes. This chapter further provides an introduction to the topic of collaborative learning and collaborative multiplayer games—and their use for game-based collaborative learning. We discuss how collaborative learning concepts are inherently used by some massive multiplayer online games, and how those concepts can be used more thoroughly by using the multiplayer paradigm for game-based collaborative learning. Further, it is shown how various multiplayer design aspects like number of players, persistency, matchmaking, interaction, or social aspects need to be considered in the design phase of a multiplayer game.
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Purpose: To explain the development and application of storytelling/narrative theory in health disparities intervention research as a way to promote health communication and behavior change among racial, ethnic, and minority populations. Findings: The proposed storytelling theory helps explain that storytelling affects changes in attitude and health behavior of the viewer through realism, identification, and transportation. Conclusions: The proposed storytelling/narrative theory can be a guide to develop culturally grounded narrative interventions that have the ability to connect with hard-to-reach populations. Clinical relevance: Narrative communication is context-dependent because it derives meaning from the surrounding situation and provides situation-based stories that are a pathway to processing story content. Although storytelling is grounded in nursing practice and education, it is underutilized in nursing interventional research. Future efforts are needed to extend theory-based narrative intervention studies designed to change attitude and behaviors that will reduce health disparities among minorities.
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We examined age-related differences in social comparison orientation and personal relative deprivation (PRD). In Study 1, participants (N = 1290) reported their tendencies to engage in social comparisons and PRD. Older adults reported lower levels of social comparison tendency and PRD, and social comparison tendency mediated the relation between age and PRD. The findings reported in Study 1 were replicated in Study 2 using a sample of participants between the ages of 18 to 30 (n = 180) and 60 + years old (n = 176). Our findings provide evidence that older adults report lower levels of social comparison tendency that, in turn, relate to lower levels of PRD.
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Almost 60 percent of Americans play videogames, which is a significant opportunity for health professionals to reach mass audiences. But although legions of fans spend countless hours playing entertainment games, player interest in health videogames quickly wanes. A good question to ask is, “Why?” A game developer with 20 years of experience offers his perspective on what may be limiting health games' appeal and what can be done about it.
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The majority of research examining massively multiplayer online game (MMOG)-based social relationships has used quantitative methodologies. The present study used qualitative semi-structured interviews with 22 Australian World of Warcraft (WoW) players to examine their experiences of MMOG-based social relationships. Interview transcripts underwent thematic analysis and revealed that participants reported experiencing an MMOG-based sense of community (a sense of belonging within the gaming or WoW community), discussed a number of different MMOG-based social identities (such as gamer, WoW player and guild or group member) and stated that they derived social support (a perception that one is cared for and may access resources from others within a group) from their relationships with other players. The findings of this study confirm that MMOG players can form gaming communities. Almost all participants accessed or provided in-game social support, and some gave or received broader emotional support. Players also identified as gamers and guild members. Fewer participants identified as WoW players. Findings indicated that changes to the game environment influence these relationships and further exploration of players' experiences could determine the optimal game features to enhance positive connections with fellow players. Copyright © 2015 John Wiley & Sons, Ltd.
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IntroductionIndividual studiesThe summary effectHeterogeneity of effect sizesSummary points
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Several systematic reviews have described health-promoting effects of serious games but so far no meta-analysis has been reported. This paper presents a meta-analysis of 54 serious digital game studies for healthy lifestyle promotion, in which we investigated the overall effectiveness of serious digital games on healthy lifestyle promotion outcomes and the role of theoretically and clinically important moderators. Findings showed serious games have small positive effects on healthy lifestyles (g = 0.252, 95% CI 0.146; 0.358) and their determinants (g = 0.334, 95% CI 0.260; 0.407), especially for knowledge. Effects on clinical outcomes were significant, but much smaller (g = 0.079, 95% CI 0.038; 0.120). Long-term effects were maintained for all outcomes except for behavior. Serious games are best individually tailored to both socio-demographic and change need information, and benefit from a strong focus on game theories or a dual theoretical foundation in both behavioral prediction and game theories. They can be effective either as a stand-alone or multi-component programs, and appeal to populations regardless of age and gender. Given that effects of games remain heterogeneous, further exploration of which game features create larger effects are needed.
Article
Objective: A feasibility study was run on an embodied exergame designed to teach 4th-12th grade students about nutrition and several U.S. Department of Agriculture (USDA) MyPlate guidelines. The study assessed efficacy on a new version of a game that was first implemented on an immersive platform and published in this journal in 2013. The earlier "Alien Health" game was redesigned for use with the Microsoft(®) (Redmond, WA) Kinect(®) sensor. Players learned about the amount of nutrients and optimizers in common food items and practiced making food choices while engaging in short cardio exercises. Subjects and Methods: Twenty 6th and 7th graders were randomly assigned to either the "Alien Health" game or a treated control condition. All engaged in "front of the classroom" performative activities. The "Alien Health" experimental group experienced the full game narrative of feeding the Alien and automated feedback on the quality of performed exercises. The control group experienced the same performative food choices at the interactive whiteboard but did no exercises. Two-week follow-up data were collected. Results: Both groups displayed statistically significant learning gains on the immediate nutrition knowledge posttest. The effect sizes from pretest to 2-week follow-up were 0.83 for the control group and 1.14 for the experimental group. Of interest is the crossover interaction from posttest to follow-up that approached significance (F 19=3.96, P<0.058). Here, the experimental group outperformed the control group for knowledge retention. Conclusions: Results suggest acceptability, feasibility, and limited efficacy in a Kinect-based game to instruct in nutrition and the USDA MyPlate icon. The follow-up test revealed that nutrition knowledge continued to increase for the experimental group that performed short cardio exercises, suggesting that short exercises and perhaps a game narrative may have helped to consolidate content memory.
Book
This book describes the reasoned action approach, an integrative framework for the prediction and change of human social behavior. it provides an up-to-date review of relevant research, discusses critical issues related to the reasoned action framework, and provides methodological and conceptual tools for the prediction and explanation of social behavior and for designing behavior change interventions.
Article
Neuroscience is often considered too advanced of a subject to teach young children; however, helping children to understand the connection between their body and brain can promote a positive attitude towards proper care of the brain. This study investigated if playing a computer game increased knowledge and interest in the brain compared with more traditional methods of learning. Participants included 169 children, 4-6 years old, attending either preschool or an afterschool program. Comparisons were made among computer game, story, and control groups. Outcomes included knowledge about brain function and interest in learning about the brain. Students were assessed after a single exposure and after multiple exposures to the game. Results indicated that the computer game generated greater knowledge gains and higher levels of interest compared with both the story and control groups. Results were consistent across single exposure and multiple exposure data. Students in the game condition had significantly higher posttest knowledge scores compared with students in both the story (β=-0.40, t 163=-5.450, P<0.001) and control condition (β=-0.57, t 163=-7.812, P<0.001). For general interest items, students in the game condition reported higher levels of interest compared with the control group (β=-0.24, t 164=-2.82, P<0.01). For content-specific interest, students in the game condition reported higher levels compared with the story group (t 109=2.05, P<0.05). This study highlights the potential value computer games play in presenting scientific and health-related content about the brain to young children.
Article
This article examines the notion of genre in video games. The main argument is that the market-based cate- gories of genre that have been developed in the context of video games obscure the new medium's crucial defining feature, by dividing them into categories (loosely) organized by their similarities to prior forms of mediation. The article explores the inherent tension between the conception of video games as a unified new media form, and the current fragmented genre-based approach that explicitly or implicitly concatenates video games with prior media forms. This tension reflects the current debate, within the fledgling discipline of Game Studies, between those who advocate narrative as the primary tool for understanding video games, "narratologists," and those that oppose this notion, "ludologists." In reference to this tension, the article argues that video game genres be examined in order to assess what kind of assumptions stem from the uncrit- ical acceptance of genre as a descriptive category. Through a critical examination of the key game genres, this article will demonstrate how the clearly defined genre boundaries collapse to reveal structural similari- ties between the genres that exist within the current genre system, defined within the context of visual aesthetic or narrative structure. The inability of the current genre descriptions to locate and highlight these particular features suggests that to privilege the categories of the visual and narrative is a failure to under- stand the medium. The article concludes by suggesting that the tension between "ludology" and "narratology" can be more constructively engaged by conceptualizing video games as operating in the interplay between these two taxonomies of genre.
Article
Using a grant from the National Institute on Drug Abuse, The Missouri Institute of Mental Health produced a series of media tools designed to teach fourth-, fifth-, and sixth-grade children from African–American churches about the science of drug addiction. Beginning with a core curriculum, we created two separate interventions. In the SpaceScouts version of the program, the content is embedded within a narrative storyline delivered via an interactive DVD. In the LockerTalk version of the program, content is delivered in a more didactic form via an interactive CD-ROM. Youths from a dozen churches were randomly assigned to one of these two conditions or to a wait-list control. We conducted pretest, posttest, and four- and eight-month follow-up evaluations. We ran an additional sample of youths through our programs during a summer camp. Analyses of our programs revealed that students who received our interventions demonstrated some modest gains in knowledge. Specifically, students who viewed SpaceScouts demonstrated improvements from baseline on one of the three sub-modules at post-test. Students who viewed LockerTalk, however, showed greater overall mastery of the content as compared to the students who viewed SpaceScouts or were in the wait-list control condition.
Article
A growing body of research suggests that smoking portrayals in movies influence adolescent tobacco use. However, the mechanism for this influence remains unclear. The aim of this paper is to provide an overview of research on narrative transportation theory, particularly as applied to movies and smoking. We propose that this theory can provide a valuable framework for guiding research on the role of entertainment media in smoking and other addictive behaviors. We review empirical work on transportation theory and highlight the psychological mechanisms underlying transportation effects. ‘Transportation into narrative worlds’ refers to cognitive, emotional and imagery engagement into a narrative (including movies and entertainment media). We link this work with research on the effects of movie smoking. Research suggests that individuals who are more highly transported into narratives show greater attitude, belief and behavior change. Transportation effects work through reducing counterarguing, creating connections (identification and liking) with characters and increasing perceptions of realism and emotional involvement. We propose several future directions and research challenges for applying a transportation framework to the issue of entertainment media effects on smoking and tobacco disparities. Understanding factors contributing to transportation may provide a more nuanced view of who will be affected by movie smoking, and understanding the psychological processes underlying narrative persuasion may guide intervention efforts. Narrative transportation theory suggests that individuals' cognitive, emotional and imagery immersion in a narrative is a key mechanism of attitude, belief and behavior change. This theory provides a potentially generative and psychologically grounded framework for increasing knowledge about the boundary conditions and processes underlying the effects of entertainment media on tobacco use.
Article
This quasi-experimental study investigated a game intervention--specifically, an alternate reality game (ARG)--as a means to influence college students' physical activity (PA). An ARG is an interactive narrative that takes place in the real world and uses multiple media to reveal a story. Three sections of a college health course (n = 115 freshman students) were assigned either to a game group that played the ARG or to a comparison group that learned how to use exercise equipment in weekly laboratory sessions. Pre- and post-intervention measures included weight, waist circumference, body mass index (BMI), percentage body fat (PBF), and self-reported moderate physical activity (MPA) and vigorous physical activity (VPA), and PA (steps/week). A significant group x time interaction (p = .001) was detected for PA, with a significant increase in PA for the game (p < .001) versus a significant decrease (p = .001) for the comparison group. Significant within-group increases for weight (p = .001), BMI (p = .001), and PBF (p = .001) were detected. A significant group x time interaction (p = .001) was detected when analyzing self-reported VPA, with both groups reporting decreases in VPA over time; however, the decrease was only significant for the comparison group (p < .001). No significant group differences were found for MPA. It is important that any intervention meet the needs and interests of its target population. Here, the ARG was designed in light of the learning preferences of today's college students--collaborative and social, experiential and media-rich. Our results provide preliminary evidence that a game intervention can positively influence PA within the college student population.
Article
The purpose of this study was to conduct a meta-analysis of computer-mediated interventions (CMIs) aimed at changing theoretical mediators of safer sex. Meta-analytic aggregation of effect sizes from k = 20 studies indicated that CMIs significantly improved HIV/AIDS knowledge, d = .276, p < .001, k = 15, N = 6,625; sexual/condom attitudes, d = .161, p < .001, k = 12, N = 5,816; and condom self-efficacy, d = .186, p < .001, k = 10, N = 3,308. Although assessed in fewer studies, CMIs also significantly increased perceived susceptibility, condom communication, and condom intentions. Effect sizes were found to be of similar magnitude to human-delivered interventions. Exploratory analysis of moderating influences detected few significant variables. Implications for the development and testing of CMIs are discussed.
Article
The impact of entertainment—education messages on beliefs, attitudes, and behavior is typically explained in terms of social cognitive theory principles. However, important additional insights regarding reasons why entertainment—education messages have effects can be derived from the processing of persuasive content in narrative messages. Elaboration likelihood approaches suggest that absorption in a narrative, and response to characters in a narrative, should enhance persuasive effects and suppress counterarguing if the implicit persuasive content is counterattitudinal. Also, persuasion mediators and moderators such as topic involvement should be reduced in importance. Evidence in support of these propositions are reviewed in this article. Research needed to extend application of these findings to entertainment—education contexts, to further develop theory in the area of persuasion and narrative, and to better account for other persuasive effects of entertainment narrative, such as those hypothesized in cultivation theory, are discussed.
Article
A growing body of research indicates that entertainment-education programming can be an effective way to deliver prosocial and health messages. Some have even speculated that entertainment-education may be more effective than overtly persuasive messages in certain circumstances. Despite empirical advances in this area, more work is needed to understand fully what makes entertainment-education unique from a message-processing standpoint. To this end, the present article has three objectives. First, the article examines the involvement with narrative storylines and characters that is fostered by entertainment programming. This includes a much-needed explication and separation of several related constructs, such as identification, parasocial interaction, similarity, and others. Second, the article reviews and synthesizes existing theories that have addressed entertainment-education message processing. Third, the article builds on these theories, presenting an expanded theoretical framework. A set of propositions is advanced and directions for future research are discussed. In total, the article offers a clarification of existing concepts that are critical to the study of entertainment-education, a synthesis of relevant theory, and a set of propositions to guide future research in entertainment-education message effects.
Conference Paper
Interactive Narrative is an approach to interactive entertainment that enables the player to make decisions that directly affect the direction and/or outcome of the narrative experience being delivered by the computer system. Interactive narrative requires two seemingly conflicting requirements: coherent narrative and user agency. We present an interactive narrative system that uses a combination of narrative control and autonomous believable character agents to augment a story world simulation in which the user has a high degree of agency with narrative plot control. A drama manager called the Automated Story Director gives plot-based guidance to believable agents. The believable agents are endowed with the autonomy necessary to carry out directives in the most believable fashion possible. Agents also handle interaction with the user. When the user performs actions that change the world in such a way that the Automated Story Director can no longer drive the intended narrative forward, it is able to adapt the plot to incorporate the user's changes and still achieve dramatic goals.
Article
Recent research demonstrates that videogames enhance literacy, attention, reaction time, and higher-level thinking. Several scholars have suggested that massively multiplayer online games (MMOs) such as Everquest and Second Life have educational potential, but we have little data about what happens when such tools are introduced in the classroom. This paper reports findings from two MMO-based courses in the context of situated learning theory. The first course, focused on the ethnography of on-line games, used the game Everquest as a vehicle for teaching research methods to 36 students in an undergraduate communication course. The second course used the game Second Life to teach the fundamentals of video- game design and criticism. Synthesizing comments from student web logs with data collected from follow- up surveys, the paper highlights key findings and offers concrete suggestions for instructors contemplating the use of multiplayer games in their own courses. Recommending that potential virtual environments be selected on the basis of genre, accessibility, and extensibility, it is suggested that game-based assignments are most effective when they build bridges between the domain of the game world and an overlapping domain of professional practice.