The Role of Enjoyment in a Serious Game for Binge Drinking Prevention: Pretest-Posttest Quasi-Experimental Study

Abstract

Background Although binge drinking peaks at age 21 to 25 years, there is limited research on the effects of serious games in this population, as well as on the process by which playing serious games impacts alcohol-related outcomes. Designed with both health behavioral theory and game theory, One Shot is an online serious game that aims to prevent binge drinking. Objective This study utilized a conceptual model for serious video game processes. Using One Shot, the model assessed the following process stages: (1) Alcohol Use Disorders Identification Test-Concise (AUDIT-C); (2) in-game factors of game time and risky alcohol decisions; (3) game enjoyment; and (4) postgame outcomes of intention to drink less and drinking refusal self-efficacy. Methods In a one-group pretest-posttest quasi-experimental design, a sample (N=550) of young adults (age 21-25 years) who reported recent binge drinking played the One Shot game. Intention to drink less and drinking refusal self-efficacy were measured at pregame and postgame, with their effects lagged in statistical analysis. Participants were presented with various scenarios in the game that pertained to risky alcohol decisions, which, along with game time, were unobtrusively recorded by the server. A structural equation model (SEM) was used to test the conceptual model, with assessments made to determine if enjoyment mediated the effects of game time and risky alcohol decisions on the 2 postgame alcohol-related outcomes. Results A well-fitting SEM demonstrated support for the multistep model, with AUDIT-C predicting risky alcohol decisions (β=.30). Risky alcohol decisions (β=−.22) and game time (β=.18) predicted enjoyment, which, in turn, predicted intention to drink less (β=.21) and drinking refusal self-efficacy (β=.16). Enjoyment significantly (P<.001) mediated the effects of game time and risky alcohol decision on intention to drink less and drinking refusal self-efficacy. Conclusions The results support a conceptual model in which staggered individual and in-game factors influence alcohol-related outcomes. Enjoyment is important for participants’ intentions to drink less and beliefs that they can refuse alcohol.

Serious Games Supporting the Prevention and Treatment of Alcohol and Drug Consumption in Youth: Scoping Review

“…Nevertheless, these positive results decreased over time after the last playing session [45]. The study by Hong et al [34] reported that participants improved from before to after the game in intention to drink less alcohol and in drinking refusal self-efficacy, where the enjoyment of the game was a key feature. The results reported in the study by Hughes et al [36] indicate that participants from the intervention group were more likely to adopt protective behaviors such as trying to stop somebody from driving after drinking and using a designated driver than participants in the control condition.…”

“…Most of the evaluated serious games (18/29, 62%) were developed to support the prevention of substance use, whereas the rest of the serious games (11/29, 38%) were focused on the enhancement of the provided treatment or on supporting individuals during specific stages of their treatment. All the serious games designed with prevention objectives (18/29, 62%) implemented their games' mechanics to facilitate the increase of knowledge on different topics, such as the negative consequences of nonmedical prescription drug use [29], the biological consequences of the abuse of inhalants [30], how the brain is affected by alcohol and other drugs [31,32], how to identify and reduce risky health behaviors [33,34] as well as carry out protective behavioral techniques [35,36], and the effects and consequences of alcohol and drug consumption [37,38].…”

“…Only a few studies (8/29, 28%) referred to a theory jointly with the particular theoretical constructs or intervention techniques used in the serious game [33,[40][41][42][43][44]47,48]. Many of the features designed in the serious games for knowledge increasing and the fostering of health behavior adoption were based on the theory of reasoned action [29,47] or the social cognitive theory (SCT) alone [33,37] or in combination with other theories such as the reinforcement theory of motivation [48], the multiple intelligences theory [35], or the protection motivation theory [34]. The serious games with a focus on treatment used theories, theoretical constructs, or intervention techniques for behavior change, such as the I-Change Model [41], coping skill training [39], cognitive bias modification of attention [49], cognitive behavioral therapy [27,45], or cue exposure therapy [40].…”

Health Promotion in Popular Web-Based Community Games Among Young People: Proposals, Recommendations, and Applications

“…To develop a game for a health promotion intervention (similar to Hong et al [ 35 ]), it is essential to consider the levels of involvement needed. It is important to consider the need for technical skills to develop and maintain the game (technical skills).…”

Serious “human papillomavirus vaccine” game for Malaysian adolescents: development and preliminary study

“…The relevance of the components in the "HPV Vaccine" game was the emotional reaction established during the game such as fear, anger, happiness, and enjoyment at each level. Hong et al stated in their study that the role of enjoyment in a serious game significantly influenced people's intentions and strengthen their belief in a healthy lifestyle [27]. The "HPV Vaccine" game is equipped with a scoring system that quantifies the achievement of players and at the same time enables grading of the knowledge shared by the game system to the players.…”