Academic journal article Journal of Health and Human Services Administration

Creating a Serious Game for Health

Academic journal article Journal of Health and Human Services Administration

Creating a Serious Game for Health

Article excerpt

This research was supported by a grant from the National Institute on Minority Health and Health Disparities (RC2 MD004760).

ABSTRACT

The prevalence of chronic illnesses continues to increase as does the cost of such care. Teaching self-management skills is more effective than solely providing information and teaching technical skills at improving health outcomes. Serious games for health provide an opportunity to support learning and health-related behavior change using messages and experiences in an engaging and entertaining format. We developed eSMART-HD with the intention of improving interactions between patients with chronic disorders and their health care providers. This paper describes the factors that we considered when creating eSMART-HD, a serious game for health.

As the population ages, the prevalence of chronic illnesses, especially diabetes and hypertension, continue to increase. The National Diabetes Information Clearinghouse (2011) estimates that diabetes affects 25.8 million people of all ages or 8.3% of the U. S. population and 31.9% of adults, age 20 and older, have hypertension (National Center for Health Statistics, 2013). While health professionals provide some chronic illness care, the great majority of care is managed by the patients themselves. The Chronic Care Model (Wagner, 1998) suggests that improvements in healthcare outcomes will occur when patients are informed and activated and have productive interactions with a prepared, proactive healthcare team.

While traditional patient education offers information and technical skills, teaching self-management skills and opportunities to practice the behaviors, such as keeping a diary of information like blood pressure, weight, or blood sugar, are more effective than information only patient education at improving clinical outcomes (Bodenheimer, Wagner and Grumbach, 2002). Serious games for health provide an opportunity to support learning and health-related behavior change using messages and experiences in an engaging and entertaining format (Hawn, 2009). They are called "serious games" because, while entertaining, they are developed with specific learning and/or behavior change goals (Howell, 2005; Baranowski, Duday, Thompson & Baranowski, 2008; Zigmond, 2008; Adams, 2010).

Sophisticated games for health are being developed using a blend of science and art (Lewis, 2007) where "playing" makes sense to the players and the players' experiences unfold within a structured situation (Rodriguez, 2006). Common characteristics of serious games for health include that games are rule-based activities that involve challenges and active participation to reach goals, provide feedback on progress made toward the goals, are immersive and experiential, provide possible social and interpersonal influences (such as coaching where virtual characters coach directly) and a wide range of interfaces (balance boards, remote controllers, camera interfaces, accelerometers, GPS systems, range of sensors to measure physical parameters of the users) (Dror, 2008; Lieberman, Chamberlin, Medina, Franklin, Sanner, and Vafiadis, 2011). Planning for game development includes many elements (Table 1) (Lewis, 2007; Brox, 2011). The table identifies design considerations and our choices in the eSMART-HD implementation. Beyond consideration of its design elements, it is essential to identify whether one is using a expert/programmatic or participatory framework, or both, as the basis for development of the content and flow of the game (Russ, 2010). For example, if we were using an expert/programmatic framework for individuals with hypertension, we might use the American Heart Association's 5-step process to control blood pressure which includes (1) About High Blood Pressure, (2) Why HBP Matters, (3) Your Risk for HBP, (4) Symptoms, Diagnosis & Monitoring of HBP, and (5) Prevention & Treatment of HBP.

We chose a participatory framework where we engaged our target audience to mine their collective intelligence about their needs and what would support them (Howe, 2008; Moore, 2006) throughout all stages of game development. …

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