Integrating Health Behavior Theory and Design Elements in Serious Games

Background Internet interventions for improving health and well-being have the potential to reach many people and fill gaps in service provision. Serious gaming interfaces provide opportunities to optimize user adherence and impact. Health interventions based in theory and evidence and tailored to psychological constructs have been found to be more effective to promote behavior change. Defining the design elements which engage users and help them to meet their goals can contribute to better informed serious games. Objective To elucidate design elements important in SPARX, a serious game for adolescents with depression, from a user-centered perspective. Methods We proposed a model based on an established theory of health behavior change and practical features of serious game design to organize ideas and rationale. We analyzed data from 5 studies comprising a total of 22 focus groups and 66 semistructured interviews conducted with youth and families in New Zealand and Australia who had viewed or used SPARX. User perceptions of the game were applied to this framework. Results A coherent framework was established using the three constructs of self-determination theory (SDT), autonomy, competence, and relatedness, to organize user perceptions and design elements within four areas important in design: computer game, accessibility, working alliance, and learning in immersion. User perceptions mapped well to the framework, which may assist developers in understanding the context of user needs. By mapping these elements against the constructs of SDT, we were able to propose a sound theoretical base for the model. Conclusions This study’s method allowed for the articulation of design elements in a serious game from a user-centered perspective within a coherent overarching framework. The framework can be used to deliberately incorporate serious game design elements that support a user’s sense of autonomy, competence, and relatedness, key constructs which have been found to mediate motivation at all stages of the change process. The resulting model introduces promising avenues for future exploration. Involving users in program design remains an imperative if serious games are to be fit for purpose.

[1]  H. Christensen,et al.  Review of internet‐based prevention and treatment programs for anxiety and depression in children and adolescents , 2010, The Medical journal of Australia.

[2]  Ralf Schwarzer,et al.  Self-efficacy in the adoption and maintenance of health behaviors: Theoretical approaches and a new model. , 1992 .

[3]  Reeva Lederman,et al.  Moderated online social therapy: Designing and evaluating technology for mental health , 2014, TCHI.

[4]  Mathijs F. G. Lucassen,et al.  The impact and utility of computerised therapy for educationally alienated teenagers: The views of adolescents who participated in an alternative education-based trial , 2016 .

[5]  Daniel L. King,et al.  Video Game Structural Characteristics: A New Psychological Taxonomy , 2009, International Journal of Mental Health and Addiction.

[6]  Martyn Standage,et al.  A test of self-determination theory in school physical education. , 2005, The British journal of educational psychology.

[7]  Dick Schoech,et al.  Gamification for Behavior Change: Lessons from Developing a Social, Multiuser, Web-Tablet Based Prevention Game for Youths , 2013 .

[8]  Kuan-Chung Chen,et al.  Motivation in online learning: Testing a model of self-determination theory , 2010, Comput. Hum. Behav..

[9]  J. Durlak,et al.  Promoting and protecting youth mental health through evidence-based prevention and treatment. , 2005, The American psychologist.

[10]  D. Dunn,et al.  The Place and Promise of Theory in Rehabilitation Psychology. , 2008, Rehabilitation psychology.

[11]  Ralf Schwarzer,et al.  Mechanisms of health behavior change in persons with chronic illness or disability: the Health Action Process Approach (HAPA). , 2011, Rehabilitation psychology.

[12]  Derek Richards,et al.  Computer-based psychological treatments for depression: a systematic review and meta-analysis. , 2012, Clinical psychology review.

[13]  Chris Dede,et al.  Immersive Interfaces for Engagement and Learning , 2009, Science.

[14]  Teresa K. Debacker,et al.  Extending the Traditional Classroom Through Online Discussion: The Role of Student Motivation , 2006 .

[15]  The design and relevance of a computerised therapy program for indigenous Māori adolescents , 2015 .

[16]  Mathijs F. G. Lucassen,et al.  The effectiveness of SPARX, a computerised self help intervention for adolescents seeking help for depression: randomised controlled non-inferiority trial , 2012, BMJ : British Medical Journal.

[17]  Reidar Hæhre,et al.  Investigating Students' Perceived Discipline Relevance Subsequent to Playing Educational Computer Games: A Personal Interest and Self-Determination Theory Approach , 2012 .

[18]  Shekhar Saxena,et al.  World Health Organization's Comprehensive Mental Health Action Plan 2013–2020 , 2014, Psychiatry and clinical neurosciences.

[19]  Robert K. Atkinson,et al.  Empirical Taxonomies of Gameplay Enjoyment: Personality and Video Game Preference , 2012, Int. J. Game Based Learn..

[20]  David Coyle,et al.  An Evaluation of a Solution Focused Computer Game in Adolescent Interventions , 2009, Clinical child psychology and psychiatry.

[21]  Harry Cayton,et al.  The flat-pack patient? Creating health together. , 2006, Patient education and counseling.

[22]  David Coyle,et al.  Qualitative Meta-Synthesis of User Experience of Computerised Therapy for Depression and Anxiety , 2014, PloS one.

[23]  Alessandro De Gloria,et al.  Mapping learning and game mechanics for serious games analysis , 2015, Br. J. Educ. Technol..

[24]  T. Fleming,et al.  ‘It’s mean!’ The views of young people alienated from mainstream education on depression, help seeking and computerised therapy , 2012 .

[25]  E. Deci,et al.  Self-determination theory: A macrotheory of human motivation, development, and health. , 2008 .

[26]  E. Brownlie,et al.  Mental Health and Transitions from Adolescence to Emerging Adulthood: Developmental and Diversity Considerations , 2014 .

[27]  R. W. Rogers,et al.  A Protection Motivation Theory of Fear Appeals and Attitude Change1. , 1975, The Journal of psychology.

[28]  F. Dark,et al.  The Therapeutic Alliance: The Key to Effective Patient Outcome? A Descriptive Review of the Evidence in Community Mental Health Case Management , 2003, The Australian and New Zealand journal of psychiatry.

[29]  Gregg C. Vanderheiden,et al.  Web content accessibility guidelines 1.0 , 2001, INTR.

[30]  Colleen Cheek,et al.  Serious games for the treatment or prevention of depression: A systematic review , 2015 .

[31]  Mirina Grosz,et al.  World Wide Web Consortium , 2010 .

[32]  Michael Kyrios,et al.  An evaluation of 'Reach Out Central': an online gaming program for supporting the mental health of young people. , 2010, Health education research.

[33]  WadleyGreg,et al.  Moderated online social therapy , 2014 .

[34]  Leanne M. Casey,et al.  Dropout from Internet-based treatment for psychological disorders. , 2010, The British journal of clinical psychology.

[35]  P. Kendall,et al.  Computer-assisted cognitive behavioral therapy for child anxiety: results of a randomized clinical trial. , 2010, Journal of consulting and clinical psychology.

[36]  I. Hickie,et al.  Increased access to evidence‐based primary mental health care: will the implementation match the rhetoric? , 2007, The Medical journal of Australia.

[37]  Evelyne F. Vallières,et al.  The Academic Motivation Scale: A Measure of Intrinsic, Extrinsic, and Amotivation in Education , 1992 .

[38]  Sean A. Munson,et al.  Social Participation in Health 2.0 , 2010, Computer.

[39]  Chris Dede,et al.  Theoretical Perspectives Influencing the Use of Information Technology in Teaching and Learning , 2008 .

[40]  A. Bandura.  Health Promotion by Social Cognitive Means , 2004, Health education & behavior : the official publication of the Society for Public Health Education.

[41]  E. Deci,et al.  A self-determination theory approach to psychotherapy: The motivational basis for effective change. , 2008 .

[42]  Mathijs F. G. Lucassen,et al.  The Design and Relevance of a Computerized Gamified Depression Therapy Program for Indigenous Māori Adolescents , 2015, JMIR serious games.

[43]  E. Deci,et al.  Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. , 2000, The American psychologist.

[44]  Etienne Wenger,et al.  Situated Learning: Legitimate Peripheral Participation , 1991 .

[45]  Bertrand Marne,et al.  A Design Pattern Library for Mutual Understanding and Cooperation in Serious Game Design , 2012, ITS.

[46]  Mathijs F. G. Lucassen,et al.  The views of lesbian, gay and bisexual youth regarding computerised self-help for depression: An exploratory study , 2013 .

[47]  E. Bordin.  The generalizability of the psychoanalytic concept of the working alliance. , 1979 .

[48]  W. Velicer,et al.  The Transtheoretical Model of Health Behavior Change , 1997, American journal of health promotion : AJHP.

[49]  S. Noar,et al.  Does tailoring matter? Meta-analytic review of tailored print health behavior change interventions. , 2007, Psychological bulletin.

[50]  Don E. Detmer,et al.  Building the national health information infrastructure for personal health, health care services, public health, and research , 2003, BMC Medical Informatics Decis. Mak..

[51]  D. Coyle,et al.  The experience of agency in human-computer interactions: a review , 2014, Front. Hum. Neurosci..

[52]  Robert Zubek,et al.  MDA : A Formal Approach to Game Design and Game Research , 2004 .

[53]  Albert Rizzo,et al.  Development and Clinical Results from the Virtual Iraq Exposure Therapy Application for PTSD , 2008, 2009 Virtual Rehabilitation International Conference.

[54]  Leonie Ellis,et al.  Views of Young People in Rural Australia on SPARX, a Fantasy World Developed for New Zealand Youth With Depression , 2014, JMIR serious games.

[55]  Heleen Riper,et al.  Internet-based cognitive behavioural therapy for subthreshold depression in people over 50 years old: a randomized controlled clinical trial , 2007, Psychological Medicine.