Integrating Health Behavior Theory and Design Elements in Serious Games

Abstract

BackgroundInternet 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.ObjectiveTo elucidate design elements important in SPARX, a serious game for adolescents with depression, from a user-centered perspective.MethodsWe 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.ResultsA 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.ConclusionsThis 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.

Annual Research Review: Digital health interventions for children and young people with mental health problems – a systematic and meta‐review

“…This aspect was also highlighted and praised by sexual minority youth, who felt that allowing them to personalise the avatar's gender and appearance reflected their real‐world experience of challenging gender expectations (Lucassen et al., ). Furthermore, the research team have analysed qualitative data from five studies of SPARX to understand how users’ perceptions and elements of the intervention map onto the autonomy, competence and relatedness aspects of self‐determination theory, which in turn have been theorised as key factors influencing engagement and adherence to computerised interventions (Cheek et al., ).…”

Youth, Technology, and HIV: Recent Advances and Future Directions

“…Cheek and colleagues (75), for example, integrated Self-Determination Theory with Gaming Theory to design an online depression treatment intervention for adolescents in Australia. Inclusion of these details may help researchers identify which technological components have greater success than others when working with youth across different settings (76).…”

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“…Besides the desire for the tool to be effective in improving wellbeing levels, young people reported that overall they would ideally like the tool to feature flexibility in choice and function [T7]. This finding is not surprising given the modern standards of current technology more generally, that provide fruitful ground for the implementation of variable and customisable tools to suit the modern consumer's needs [73,74]. When considering that contemporary digital health interventions, such as E-health, are characterised by their ability to increase the effectiveness of and adherence to therapy, the clinical implications of the incorporation of flexible features in self-management tools can be of paramount importance.…”