Health Video Games Spark Interest, Try to Gain Traction

Debra Lieberman, PhD, director of the Center for Digital Games Research at the University of California, Santa Barbara, is a huge supporter of using video games—and digital interventions in general—for health.

She has seen the power they can have. She knows what works. But she also knows what doesn’t work. And creating a good video game isn’t as easy as it looks. She says some outstanding health games have addressed diabetes self-management, asthma self-management, immunology, smoking prevention, cancer-treatment adherence, pain distraction, physical activity, cognitive and physical therapy, ADD, autism, PTSD and much more.

“Some organizations are making health games—well-meaning people trying to do what’s best—but their design team does not know how to promote health behavior change or improve health knowledge, nor do they know how to make a fun, entertaining and engaging game that people really want to play,” she says. “So you get games that aren’t impactful as health interventions and are not that much fun to play. I applaud the effort; however, to help make a health game both effective and fun, the design team needs input from various specialists, such as clinical practitioners in the health area, experts who know the interests and abilities of the target population, health promotion designers and researchers who know how to integrate behavior change strategies into the design of entertainment games, and can conduct user testing to make improvements during game development, and—very importantly—game designers and artists who know how to make great, compelling, challenging, fun games.”

So what makes a game work? Here are a few components to include in a basic toolkit:

1. A sense of user control and agency. “Players should have choices and a sense that they can make things happen in a game,” Dr. Lieberman says.
2. The ability to adapt to skill level. As players improve their skills, the game should adapt and become increasingly difficult so it will remain compelling and challenging. Likewise, if playing becomes so difficult that players cannot succeed, the game should adjust to become slightly easier to play so players won’t give up in frustration.
3. Rehearsal of skills with real application to the player’s own life. Some health games can be designed to hone skills that are relevant to the player’s lifestyle habits and health regimen. These games might challenge the player to develop and apply their knowledge and skills as they control their game character, or avatar, to carry out health behaviors in the course of a simulated typical day or week. The game can provide real-time feedback in context, showing the health benefits or drawbacks of the avatar’s behaviors.
4. Improvement of self-efficacy. Dr. Lieberman says, “Usually we know, or can easily find out, how to take care of our health or manage the self-care aspects of a chronic condition, but we may lack self-efficacy for carrying out a health behavior—the confidence and belief that we are able to do it. Games can improve self-efficacy by giving us opportunities to strive and then succeed, demonstrating to ourselves that we can overcome the obstacles we thought were impossible to handle. For example, some health behaviors may be time consuming, expensive, uncomfortable, boring or hard to do, and medications may have side effects. A game can give players a safe virtual world in which they can address those obstacles and rehearse new skills, and thereby gain the self-efficacy to carry out the health behaviors in their own lives, in spite of the obstacles.”
5. Characters that are similar to the player. “People tend to pay attention to and emulate the behaviors of characters that are similar to them in looks, demographics, lifestyle, culture, attitudes and so on,” Dr. Lieberman says, referring to the concept of homophily. “We can take homophily a step further and note that people tend to be interested in any character that has their health condition, even if the character doesn’t look like them.”
6. Entertainment value. Games are rule-based activities that involve challenge to reach a goal and that provide feedback on progress toward the goal. Health video games should offer compelling challenges in a way that is fun and/or involving.
7. Feedback. A good game provides immediate progress feedback and, when appropriate, a way to track feedback and progress over time. For example, a mobile game that supports a player’s workouts may provide feedback on a runner’s current speed and heart rate, and also keep a cumulative record of data about the runner’s previous workouts.
8. Teamwork. “Research on teamwork finds that team members will work harder and will persist for a longer period of time when the team depends on their efforts, because they do not want to let their teammates down,” says Dr. Lieberman. “Teamwork has been used successfully in certain health games to improve players’ motivation and effort.”

—Thomas R. Collins