Serious games for smoking prevention and cessation: A systematic review of game elements and game effects

Abstract

Objective Serious health games might have the potential to prevent tobacco smoking and its health consequences, depending on the inclusion of specific game elements. This review aimed to assess the composition of serious games and their effects on smoking initiation prevention and cessation and behavioral determinants. Materials and Methods We systematically searched MEDLINE, Embase, PsycINFO, and Web of Science for publications that evaluated serious games aimed at changing smoking behavior or behavioral determinants. A taxonomy by King et al was used to classify game elements. Results We identified 15 studies, evaluating 14 unique serious games. All games combined multiple game elements (mean 5.5; range, 3-10). Most frequently used were general and intermittent rewards, theme and genre features, and punishments. Six studies on smoking prevention together assessed 20 determinants and found statistically significant positive effects for 8 determinants (eg, attitude, knowledge, intention). Of 7 studies on smoking cessation, 5 found positive, statistically significant effects on smoking cessation or status. These studies found statistically significant positive effects for 6 of 12 determinants (eg, self-efficacy, attitude, intention). The majority of included studies had poor or fair methodological quality, lacked follow-up measures, and had fixed (as opposed to free, on-demand) play sessions. Conclusions Serious games included multiple types of game elements. The evidence from a number of studies suggests that games may have positive effects on smoking-related outcomes, particularly smoking cessation. However, as most studies had important methodological limitations, stronger designs are needed to demonstrate, quantify, and understand the effects of serious games.

Mobile Health for Smoking Cessation Among Disadvantaged Young Women During and After Pregnancy: User-Centered Design and Usability Study

“…According to an inventory by Paige et al [ 37 ], processes of change that aid people in moving through stages of behavioral change are widely applied in mHealth apps for smoking cessation, including Kindle. Moreover, in accordance with other research [ 8 , 39 - 42 ], the first phase highlighted the importance of supportive social networks for smoking cessation.…”

“…One of the user requirements of Kindle that we identified was the use of game elements and social interactions. Previous research has also suggested the potential of social features in serious games for smoking cessation [ 8 ]. Moreover, pregnant women in other studies also highlighted the usefulness and playfulness of social interaction functionalities within mHealth [ 10 ].…”

“…Mobile health (mHealth) apps appear to have positive effects on smoking cessation [ 6 , 7 ], and the inclusion of multiple game elements seems particularly promising [ 8 ]. In general, pregnant women have been found to frequently use eHealth and mHealth [ 9 ] and consider mHealth as a useful and playful tool [ 10 ].…”

An innovation involving self-surveillance and serious gaming to increase smoking quit rate: Protocol for a pilot randomized controlled trial

“…A randomized controlled trial of Nicot 22 , a video game in which players crush virtual cigarettes in a 3D game environment, reported 13% increase in smoking cessation rates compared with a balloon popping game. Derksen et al 23 have shown favorable outcomes in smoking cessation associated with serious gaming in their recent systematic review. However, they reported that most studies in the systematic review had important methodological limitations, which failed to adequately demonstrate, quantify, and understand the effects of serious games on the outcomes 23 .…”

“…Derksen et al 23 have shown favorable outcomes in smoking cessation associated with serious gaming in their recent systematic review. However, they reported that most studies in the systematic review had important methodological limitations, which failed to adequately demonstrate, quantify, and understand the effects of serious games on the outcomes 23 .…”