Developing Theory-Driven, Evidence-Based Serious Games for Health: Framework Based on Research Community Insights

Abstract

Background The idea of using serious games to effectuate better outcomes in health care has gained significant traction among a growing community of researchers, developers, and health care professionals. Many now recognize the importance of creating evidence-based games that are purposefully designed to address physical and mental health challenges faced by end users. To date, no regulatory resources have been established to guide the development of serious games for health (SGH). Developers must therefore look elsewhere for guidance. Although a more robust level of evidence exists in the research literature, it is neither structured nor is there any clear consensus. Developers currently use a variety of approaches and methodologies. The establishment of a well-defined framework that represents the consensus views of the SGH research community would help developers improve the efficiency of internal development processes, as well as chances of success. A consensus framework would also enhance the credibility of SGH and help provide quality evidence of their effectiveness. Objective This research aimed to (1) identify and evaluate the requirements, recommendations, and guidelines proposed by the SGH community in the research literature, and; (2) develop a consensus framework to guide developers, designers, researchers, and health care professionals in the development of evidence-based SGH. Methods A critical review of the literature was performed in October to November 2018. A 3-step search strategy and a predefined set of inclusion criteria were used to identify relevant articles in PubMed, ScienceDirect, Institute of Electrical and Electronics Engineers Xplore, CiteSeerX, and Google Scholar. A supplemental search of publications from regulatory authorities was conducted to capture their specific requirements. Three researchers independently evaluated the identified articles. The evidence was coded and categorized for analysis. Results This review identified 5 categories of high-level requirements and 20 low-level requirements suggested by the SGH community. These advocate a methodological approach that is multidisciplinary, iterative, and participatory. On the basis of the requirements identified, we propose a framework for developing theory-driven, evidence-based SGH. It comprises 5 stages that are informed by various stakeholders. It focuses on building strong scientific and design foundations that guide the creative and technical development. It includes quantitative trials to evaluate whether the SGH achieve the intended outcomes, as well as efforts to disseminate trial findings and follow-up monitoring after the SGH are rolled out for use. Conclusions This review resulted in the formulation of a framework for developing theory-driven, evidence-based SGH that represents many of the requirements set out by SGH stakeholders in the literature. It covers all aspects of the development process (scientific, technological, and design) and is transparently described in sufficient detail to allow SGH stakeholders to implement it in a wide variety of projects, irrespective of discipline, health care segments, or focus.

The RETAIN Simulation-Based Serious Game—A Review of the Literature

“…As serious games gain traction in healthcare, it is important that evidence-based games follow a structured framework to enhance credibility, provide quality evidence of effectiveness, and overcome barriers to uptake [22]. Using a methodological approach consisting of: purposeful design, quality evaluation, and dissemination of findings, contributes to the growing body of evidence of serious games as a credible training approach for improving educational outcomes in HCPs and eventual clinical outcomes for patients [22]. While other serious games have been developed for neonatology [11], RETAIN represents a unique simulation-based serious game for neonatal resuscitation training, as is well-described in the research literature [13,14,17,18].…”

A Picture is Worth a Thousand Words: The Role of Survey Training Materials in Stated-Preference Studies

“…The respondent was required to click through and read each page of text. 1 The animated storyline was developed with assistance from a company that developed and applied their theorydriven, evidence-based approach to develop interactive educational tools such as serious games (MindBytes, http:// www.mindb ytes.be [29]). As advised by Reeve [30], a storyline was created and a narrative developed for an avatar (a figure representing a person).…”

A Web-Based Serious Game for Health to Reduce Perioperative Anxiety and Pain in Children (CliniPup): Pilot Randomized Controlled Trial

“…The data collected within this pilot trial support the conclusion that an SGH, when developed using a scientific methodology such as the SERES Framework, may be particularly valuable as an intervention to educate and change behavior in health care settings [34]. This may be particularly true for a pediatric population, but the generalizability of the approach implemented also suggests that this method could be applicable in adult populations as well.…”