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Current Research on Games for Managing Chronic Conditions, Lieberman, 6-13-12

Debra Lieberman
Debra Lieberman

This document summarizes a presentation on current research into games for managing chronic conditions. It identifies several chronic conditions for which games have been developed, including diabetes, asthma, HIV/AIDS, and various others. It then analyzes patterns in game designs, grouping games into genres like knowledge games, self-management skill games, and simulation games. It discusses common game elements like characters, settings, and intended outcomes. Examples of existing games are provided, such as The Diabetic Dog for diabetes and Bronkie the Bronchiasaurus for asthma. Research on games like Re-Mission is also mentioned. The presentation aims to identify innovations and new ideas in designing games for chronic disease self-management.

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Current Research on Games for Managing Chronic Conditions Presentation to the Games for Health Conference Boston, MA Debra Lieberman, Erica Biely, Ramsey Nijem, & Marta Delcor UC Santa Barbara June 13, 2012
We found games & research on these chronic conditions Diabetes Crohns disease Asthma HIV / AIDS Kidney disease Multiple sclerosis Malaria Heart Disease Hepatitis Cancer Tuberculosis STDs, STIs Sickle cell disease Autism Hypertension Depression Arthritis Alzheimers Cystic fibrosis
Some patterns / similarities emerged Can we boil most self-management games down to just a few game designs? Likewise, is the research limited to a few repeating study designs and research questions? So, I ask you to provide counter-examples: Where are examples of innovation? What are your ideas for innovation? Here are the patterns we found in todays games:
5 chronic condition game genres or formats 1. Knowledge games 2. Self-management skill games 3. Simulation games 4. Nurturing games 5. Goal setting and social support games (not discussed today; used mostly for fitness and prevention, but there is great potential for disease self-management) Some games are hybrids of two or more genres
Characters 1. No characters (puzzles, card games) 2. Fantasy characters 3. Realistic characters 4. Self character (avatar) 5. Helper character / tutor / doctor / sage 6. Co-learner character that models the joy of discovery 7. Role model characters (positive, negative, transitional) 8. Enemies that cause illness Some characters have the chronic condition, some do not
Settings 1. No setting (puzzles, card games) 2. Fantasy worlds 3. Real world 4. Inside the human body
Intended outcomes 1. Knowledge gain; deeper understanding 2. Skill development and rehearsal Health decision-making Self-care What to do in social situations 3. Changes in attitudes, risk perceptions, empathy, self-concepts all can lead to behavior change 4. Social support instrumental and emotional 5. Motivation for health behavior change in real life
Repurposed off-the-shelf commercial games could be used for chronic conditions Aerobic fitness and weight loss Dance games, Wii Fit, Kinect games Mental acuity, attention, memory Scrabble, Sudoku, Tetris, Dakim, Brain Age Physical therapy and rehabilitation Wii balance board, Kinect motion sensor Phobia reduction Auto racing games to address fear of driving
Theory integrated into the game design For example, Extended Parallel Process Model (Witte) Game presents a threat message Players feel threat of the chronic condition: Perceived severity, susceptibility Game instills efficacy through rehearsal of self- management Players see the efficacy of the recommended response as they rehearse that response Self-efficacy, response efficacy
R2 = .03 Perceived susceptibility .18* .35*** R2 = .15 ). Perceived severity R2 = .19 Playing the health game Improved behaviors .20** .35*** and health outcomes R2 = .05 Self efficacy for self-management behaviors .17** -.11** .28*** R2 = .08 Response efficacy of self-management behaviors
Here are examples of games for management of chronic conditions The Diabetic Dog (diabetes) Re-Mission (cancer) Bronkie the Bronchiasaurus (asthma) Heart Sense (heart disease)
The Diabetic Dog
The Diabetic Dog Nurturing of a patient character Simulation of chronic disease self-management Underlying multivariate algorithm of actions and effects Make health decisions and see the consequences The nurtured characters health outcomes (good outcomes are needed to win the game) are based on the players health decisions in the game
Bronkie the Bronchiasaurus
Bronkie the Bronchiasaurus Role playing adventure game Fantasy characters Set in the real world (real consequences of good or bad asthma self-management) Nurturing of ones own character The characters health outcomes (good outcomes are needed to win the game) are based on the players health decisions in the game
Re-Mission Produced by HopeLab, Palo Alto, CA For teens and young adults who have cancer To improve cancer knowledge, adherence, sel f-care
Re-Mission Role playing adventure game Fantasy characters Set in the human body Nurturing of characters The nurtured characters health outcomes (good outcomes are needed to win the game) are based on the players health decisions in the game
Heart Sense
Heart Sense Role playing game in which you help the hero try to solve a crime and simultaneously rescue his career and find romance. However, as the hero, some of the many characters you might get clues from, need your help to deal with heart attacks before they or others can help you. Since, for their own reasons, they often don't believe they are having a heart attack or don't want to take care of it promptly, there are significant obstacles to helping these characters help themselves. And if you prefer to harm these characters, you are free to do so, but watch out, your own future will be affected as well!
Heart Sense Role playing adventure game Realistic characters Set in the real world Nurturing of characters The nurtured characters health outcomes (good outcomes are needed to win the game) are based on the players health decisions in the game
Research examples Re-Mission, Bronkie Randomized controlled trials (no slides, just speakers description)
Do you recommend any disease self-management games with different formats and behavior change strategies? Innovative ideas for designing disease self-management games?
Thank you! Debra Lieberman, Erica Biely, Ramsey Nijem, Marta Delcor Health Games Research UC Santa Barbara www.healthgamesresearch.org Database: www.healthgamesresearch.org/db

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Current Research on Games for Managing Chronic Conditions, Lieberman, 6-13-12

  • 1. Current Research on Games for Managing Chronic Conditions Presentation to the Games for Health Conference Boston, MA Debra Lieberman, Erica Biely, Ramsey Nijem, & Marta Delcor UC Santa Barbara June 13, 2012
  • 2. We found games & research on these chronic conditions Diabetes Crohns disease Asthma HIV / AIDS Kidney disease Multiple sclerosis Malaria Heart Disease Hepatitis Cancer Tuberculosis STDs, STIs Sickle cell disease Autism Hypertension Depression Arthritis Alzheimers Cystic fibrosis
  • 3. Some patterns / similarities emerged Can we boil most self-management games down to just a few game designs? Likewise, is the research limited to a few repeating study designs and research questions? So, I ask you to provide counter-examples: Where are examples of innovation? What are your ideas for innovation? Here are the patterns we found in todays games:
  • 4. 5 chronic condition game genres or formats 1. Knowledge games 2. Self-management skill games 3. Simulation games 4. Nurturing games 5. Goal setting and social support games (not discussed today; used mostly for fitness and prevention, but there is great potential for disease self-management) Some games are hybrids of two or more genres
  • 5. Characters 1. No characters (puzzles, card games) 2. Fantasy characters 3. Realistic characters 4. Self character (avatar) 5. Helper character / tutor / doctor / sage 6. Co-learner character that models the joy of discovery 7. Role model characters (positive, negative, transitional) 8. Enemies that cause illness Some characters have the chronic condition, some do not
  • 6. Settings 1. No setting (puzzles, card games) 2. Fantasy worlds 3. Real world 4. Inside the human body
  • 7. Intended outcomes 1. Knowledge gain; deeper understanding 2. Skill development and rehearsal Health decision-making Self-care What to do in social situations 3. Changes in attitudes, risk perceptions, empathy, self-concepts all can lead to behavior change 4. Social support instrumental and emotional 5. Motivation for health behavior change in real life
  • 8. Repurposed off-the-shelf commercial games could be used for chronic conditions Aerobic fitness and weight loss Dance games, Wii Fit, Kinect games Mental acuity, attention, memory Scrabble, Sudoku, Tetris, Dakim, Brain Age Physical therapy and rehabilitation Wii balance board, Kinect motion sensor Phobia reduction Auto racing games to address fear of driving
  • 9. Theory integrated into the game design For example, Extended Parallel Process Model (Witte) Game presents a threat message Players feel threat of the chronic condition: Perceived severity, susceptibility Game instills efficacy through rehearsal of self- management Players see the efficacy of the recommended response as they rehearse that response Self-efficacy, response efficacy
  • 10. R2 = .03 Perceived susceptibility .18* .35*** R2 = .15 ). Perceived severity R2 = .19 Playing the health game Improved behaviors .20** .35*** and health outcomes R2 = .05 Self efficacy for self-management behaviors .17** -.11** .28*** R2 = .08 Response efficacy of self-management behaviors
  • 11. Here are examples of games for management of chronic conditions The Diabetic Dog (diabetes) Re-Mission (cancer) Bronkie the Bronchiasaurus (asthma) Heart Sense (heart disease)
  • 13. The Diabetic Dog Nurturing of a patient character Simulation of chronic disease self-management Underlying multivariate algorithm of actions and effects Make health decisions and see the consequences The nurtured characters health outcomes (good outcomes are needed to win the game) are based on the players health decisions in the game
  • 15. Bronkie the Bronchiasaurus Role playing adventure game Fantasy characters Set in the real world (real consequences of good or bad asthma self-management) Nurturing of ones own character The characters health outcomes (good outcomes are needed to win the game) are based on the players health decisions in the game
  • 16. Re-Mission Produced by HopeLab, Palo Alto, CA For teens and young adults who have cancer To improve cancer knowledge, adherence, sel f-care
  • 17. Re-Mission Role playing adventure game Fantasy characters Set in the human body Nurturing of characters The nurtured characters health outcomes (good outcomes are needed to win the game) are based on the players health decisions in the game
  • 19. Heart Sense Role playing game in which you help the hero try to solve a crime and simultaneously rescue his career and find romance. However, as the hero, some of the many characters you might get clues from, need your help to deal with heart attacks before they or others can help you. Since, for their own reasons, they often don't believe they are having a heart attack or don't want to take care of it promptly, there are significant obstacles to helping these characters help themselves. And if you prefer to harm these characters, you are free to do so, but watch out, your own future will be affected as well!
  • 20. Heart Sense Role playing adventure game Realistic characters Set in the real world Nurturing of characters The nurtured characters health outcomes (good outcomes are needed to win the game) are based on the players health decisions in the game
  • 21. Research examples Re-Mission, Bronkie Randomized controlled trials (no slides, just speakers description)
  • 22. Do you recommend any disease self-management games with different formats and behavior change strategies? Innovative ideas for designing disease self-management games?
  • 23. Thank you! Debra Lieberman, Erica Biely, Ramsey Nijem, Marta Delcor Health Games Research UC Santa Barbara www.healthgamesresearch.org Database: www.healthgamesresearch.org/db