Stories in Games for Health: More Pros or Cons?

Baranowski, Tom; Lu, Amy Shirong; Buday, Richard; Lyons, Elizabeth; Schell, Jesse; Russoniello, Carmen

doi:10.1089/g4h.2013.0052

Cited by 19 publications

(12 citation statements)

References 43 publications

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“…The ideal implementation of gamification would, therefore, harness intrinsic motivation and the types of extrinsic motivation that are most likely to be internalized, such as identified or integrated regulation [16]. Previous research in the health field has expanded on properties of video games that may be more compatible with intrinsic motivation, such as narrative, fantasy, and interactivity [21-23]. These properties may also be associated with improved emotional intelligence and regulation [24].…”

Section: Introductionmentioning

confidence: 99%

Gamification in Apps and Technologies for Improving Mental Health and Well-Being: Systematic Review

Cheng¹,

Davenport²,

Johnson³

et al. 2019

JMIR Ment Health

172

143

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Background There is little research on the application of gamification to mental health and well-being. Furthermore, usage of gamification-related terminology is inconsistent. Current applications of gamification for health and well-being have also been critiqued for adopting a behaviorist approach that relies on positive reinforcement and extrinsic motivators. Objective This study aimed to analyze current applications of gamification for mental health and well-being by answering 3 research questions (RQs). RQ1: which gamification elements are most commonly applied to apps and technologies for improving mental health and well-being? RQ2: which mental health and well-being domains are most commonly targeted by these gamified apps and technologies? RQ3: what reasons do researchers give for applying gamification to these apps and technologies? A systematic review of the literature was conducted to answer these questions. Methods We searched ACM Digital Library, CINAHL, Cochrane Library, EMBASE, IEEE Explore, JMIR, MEDLINE, PsycINFO, PubMed, ScienceDirect, Scopus, and Web of Science for qualifying papers published between the years 2013 and 2018. To answer RQ1 and RQ2, papers were coded for gamification elements and mental health and well-being domains according to existing taxonomies in the game studies and medical literature. During the coding process, it was necessary to adapt our coding frame and revise these taxonomies. Thematic analysis was conducted to answer RQ3. Results The search and screening process identified 70 qualifying papers that collectively reported on 50 apps and technologies. The most commonly observed gamification elements were levels or progress feedback, points or scoring, rewards or prizes, narrative or theme, personalization, and customization; the least commonly observed elements were artificial assistance, unlockable content, social cooperation, exploratory or open-world approach, artificial challenge, and randomness. The most commonly observed mental health and well-being domains were anxiety disorders and well-being, whereas the least commonly observed domains were conduct disorder and bipolar disorders. Researchers’ justification for applying gamification to improving mental health and well-being was coded in 59% (41/70) of the papers and was broadly divided into 2 themes: (1) promoting engagement and (2) enhancing an intervention’s intended effects. Conclusions Our findings suggest that the current application of gamification to apps and technologies for improving mental health and well-being does not align with the trend of positive reinforcement critiqued in the greater health and well-being literature. We also observed overlap between the most commonly used gamification techniques and existing behavior change frameworks. Results also suggest that the application of gamification is not driven by health behavior change theory, and that many researchers may treat gamification as a black box without consideration for its underlying mechanisms. We call for the inclusion of more comprehensive and explicit descriptions of how gamification is applied and the standardization of applied games terminology within and across fields.

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Section: Introductionmentioning

confidence: 99%

Gamification in Apps and Technologies for Improving Mental Health and Well-Being: Systematic Review

Cheng¹,

Davenport²,

Johnson³

et al. 2019

JMIR Ment Health

172

143

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“…The question of what role narrative should play in games for health has elicited divergent opinions [62]. Stories have played central or peripheral roles in serious games, often depending on the game’s behavioral objectives and, concomitantly, its pedagogical approach.…”

Section: Discussionmentioning

confidence: 99%

Interactive Narrative in a Mobile Health Behavioral Intervention (Tumaini): Theoretical Grounding and Structure of a Smartphone Game to Prevent HIV Among Young Africans

Winskell¹,

Sabben²,

Obong’o³

2019

JMIR Serious Games

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The increasing availability of smartphones, including in low-income countries, offers an unprecedented opportunity to reach individuals with innovative health promotion interventions. Electronic games delivered via smartphone offer promising avenues for sexual health promotion and HIV prevention, especially for young people. By giving players real agency in a virtual and safe environment, well-designed games can provide a level of experiential learning unparalleled by many other behavioral interventions. The design of effective games for health relies on multidisciplinary insight and expertise. However, relatively few studies discuss the theoretical understanding underlying their intervention. Making explicit the theoretical grounding of a game-based intervention allows articulation of assumptions and strategies, anticipation of outcomes, and evaluation of impacts (including intermediate effects), thereby increasing understanding of pathways to change, with a view to contributing to the development of more effective games. It also helps strengthen the credibility and improve the accountability of games for health. We present the multidisciplinary theoretical framework—integrating intervention design, mediators, and behavioral outcomes—and the structure of an HIV prevention game for young African adolescents that has shown promise in a randomized pilot study in Western Kenya. The central component of Tumaini ( hope for the future in Kiswahili) is an interactive role-playing narrative in which the player makes choices for characters that determine how their paths unfold. In addition, a series of mini-games reinforce skills, and the “My Story” component links the game world to the player’s own life and goals, and a reward system motivates continued play. With its “choose-your-own-adventure” format, Tumaini is intended to be replayed so that players can experience the consequences resulting from different choices made in the role-playing narrative. Grounded in theories of narrative and applied communication and in social behavioral theories, especially Social Cognitive Theory, Tumaini is designed to help young adolescents acquire the information, skills, and motivation they need to avoid and reduce sexual risks. We close by situating Tumaini within discussion of the theory and practice of using interactive narrative in health promotion, with a view to furthering theoretical elaboration.

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“…14 A narrative may moreover decrease cognitive load, reduce counterarguing, increase motivation, create a personal experience, and trigger feelings of presence. 4,14,15 Digital games are promising tools to reach adolescents, since they are preferred to traditional education and exercises. 16,17 Serious digital games for health promotion address a diverse range of health topics, 5 and have to appeal to a broad target group.…”

Section: Introductionmentioning

confidence: 99%

“…21 Serious digital games wish to involve nonhabitual gamers, 12 or those less attracted to digital games such as girls 22 and adolescents of lower socioeconomic status (SES) background. 21,23,24 Narratives have been identified as an important game element for nonhabitual players 12 ; when players are unaware of or resistant to the desired health behavior 15 ; and they were suggested as a way to increase appeal and effects of serious digital health games among adolescents of lower SES background. 21 Research on narrative preferences in serious games is however scarce, and more research focuses on narrative preferences in educational games.…”

Section: Introductionmentioning

confidence: 99%

Which Game Narratives Do Adolescents of Different Gameplay and Sociodemographic Backgrounds Prefer? A Mixed-Methods Analysis

Schwarz

Mertens

Simons

et al. 2019

Games for Health Journal

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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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Stories in Games for Health: More Pros or Cons?

Cited by 19 publications

References 43 publications

Gamification in Apps and Technologies for Improving Mental Health and Well-Being: Systematic Review

Gamification in Apps and Technologies for Improving Mental Health and Well-Being: Systematic Review

Interactive Narrative in a Mobile Health Behavioral Intervention (Tumaini): Theoretical Grounding and Structure of a Smartphone Game to Prevent HIV Among Young Africans

Which Game Narratives Do Adolescents of Different Gameplay and Sociodemographic Backgrounds Prefer? A Mixed-Methods Analysis

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