Bard O. Wartena

Bias Blaster – Aiding Cognitive Bias Modification- Interpretation through a bubble shooter induced gameflow

This paper presents the design and development of Bias Blaster. Bias Blaster is a proof-of-concept integrated bubble-shooter game with an evidence-based therapeutic intervention, i.e., Cognitive Bias Modification Interpretation (CBM-I). The game is tailor-made for patients of the Dutch national mental health organization (GGZ) recovering from a First-Episode Psychosis (FEP). Cognitive Bias Modification- Interpretation treats the self-stigma and its associated interpretation bias as experienced by patients recovering from a FEP. The amount and frequency of CBM-I items and training is regulated by the patient, through an integrated game-mechanic of the modified bubble shooter. The game implements a motivational and reinforcement paradigm, which paves the way for the use of the rigorous and demanding CBM-I therapy. Moreover, Bias Blaster exploits the natural game flow of the bubble shooter to increase resilience and adherence throughout the treatment of FEP patients. This paper presents the design and development process of the game. The lessons learned are summarized in implications for the design of serious games: design for “acceptance“ and as a “serious therapeutic”.

Design for Transfer

This paper explores the use of design for transfer in simulations and serious games. Key in this study is the hypothesis that meaningful play can be achieved by designing for figural transfer by the use of metaphorical recontextualisation. The Game Transfer Model (GTM) is introduced as a tool for designing and thinking about serious game design, stretching the possibilities from high-fidelity simulations to metaphorical fantasy worlds. Key for in-game learning experience is the presence of conceptual continuity defined by the congruence of fidelity-elements. The GTM differentiates between realisticness and realism. Where simulations use the road of literal transfer and therefore relies on realisticness and high-fidelity, figural transfer can be a guiding principle for serious game design, using metaphorical recontextualisation to maintain conceptual continuity. Conceptual continuity aligns fidelity and enables the game to connect its serious content to the realities of life.

iLift: A health behavior change support system for lifting and transfer techniques to prevent lower-back injuries in healthcare

OBJECTIVE Lower back problems are a common cause of sick leave of employees in Dutch care homes and hospitals. In the Netherlands over 40% of reported sick leave is due to back problems, mainly caused by carrying out heavy work. The goal of the iLift project was to develop a game for nursing personnel to train them in lifting and transfer techniques. The main focus was not on testing for the effectiveness of the game itself, but rather on the design of the game as an autogenous trigger and its place in a behavioral change support system. In this article, the design and development of such a health behavior change support system is addressed, describing cycles of design and evaluation. METHODS (a) To define the problem space, use context and user context, focus group interviews were conducted with Occupational Therapists (n=4), Nurses (n=10) and Caregivers (n=12) and a thematic analysis was performed. We interviewed experts (n=5) on the subject of lifting and transferring techniques. (b) A design science research approach resulted in a playable prototype. An expert panel conducted analysis of video-recorded playing activities. (c) Field experiment: We performed a dynamic analysis in order to investigate the feasibility of the prototype through biometric data from player sessions (n=620) by healthcare professionals (n=37). RESULTS (a) Occupational Therapists, Nurses and Caregivers did not recognise a lack of knowledge with training in lifting and transferring techniques. All groups considered their workload, time pressure and a culturally determined habit to place the patients well being above their own as the main reason not to apply appropriate lifting and transferring techniques. This led to a shift in focus from a serious game teaching lifting and transferring techniques to a health behavior change support system containing a game with the intention to influence behavior. (b) Building and testing (subcomponents of) the prototype resulted in design choices regarding players perspective, auditory and visual feedback, overall playability and perceived immersiveness. This design process also addressed the behavior shaping capacities of the game and its place within the health behavior change support system. An expert panel on lifting and transferring techniques validated the provoked in-game activities as being authentic. (c) Regression analysis showed an increase of the game score and dashboard score when more sessions were played, indicating an in-game training effect. A post-hoc test revealed that from an average of 10 playing sessions or more, the dashboard score and the game score align, which indicates behavioral change towards executing appropriate static lifting and transferring techniques. CONCLUSIONS Data gathered in the final field test shows an in-game training effect, causing players to exhibit correct techniques for static lifting and transferring techniques but also revealed the necessity for future social system development and especially regarding intervention acceptance. Social system factors showed a strong impact on the games persuasive capacities and its autogenous intent.

The Role of Transfer in Designing Games and Simulations for Health: Systematic Review

Background The usefulness and importance of serious games and simulations in learning and behavior change for health and health-related issues are widely recognized. Studies have addressed games and simulations as interventions, mostly in comparison with their analog counterparts. Numerous complex design choices have to be made with serious games and simulations for health, including choices that directly contribute to the effects of the intervention. One of these decisions is the way an intervention is expected to lead to desirable transfer effects. Most designs adopt a first-class transfer rationale, whereas the second class of transfer types seems a rarity in serious games and simulations for health. Objective This study sought to review the literature specifically on the second class of transfer types in the design of serious games and simulations. Focusing on game-like interventions for health and health care, this study aimed to (1) determine whether the second class of transfer is recognized as a road for transfer in game-like interventions, (2) review the application of the second class of transfer type in designing game-like interventions, and (3) assess studies that include second-class transfer types reporting transfer outcomes. Methods A total of 6 Web-based databases were systematically searched by titles, abstracts, and keywords using the search strategy (video games OR game OR games OR gaming OR computer simulation*) AND (software design OR design) AND (fidelity OR fidelities OR transfer* OR behaviour OR behavior). The databases searched were identified as relevant to health, education, and social science. Results A total of 15 relevant studies were included, covering a range of game-like interventions, all more or less mentioning design parameters aimed at transfer. We found 9 studies where first-class transfer was part of the design of the intervention. In total, 8 studies dealt with transfer concepts and fidelity types in game-like intervention design in general; 3 studies dealt with the concept of second-class transfer types and reported effects, and 2 of those recognized transfer as a design parameter. Conclusions In studies on game-like interventions for health and health care, transfer is regarded as a desirable effect but not as a basic principle for design. None of the studies determined the second class of transfer or instances thereof, although in 3 cases a nonliteral transfer type was present. We also found that studies on game-like interventions for health do not elucidate design choices made and rarely provide design principles for future work. Games and simulations for health abundantly build upon the principles of first-class transfer, but the adoption of second-class transfer types proves scarce. It is likely to be worthwhile to explore the possibilities of second-class transfer types, as they may considerably influence educational objectives in terms of future serious game design for health.

Play It Safe; A Situational Game for Occupational Safety

This chapter describes the design choices and theoretical constructs that have led to the development of an occupational safety game, going by the name Play it Safe. Play it Safe is a tower defense game that uses situational data collected by employees, during their daily work, to impact the parameters of the video game. These data are gathered through a safety campaign named, Count Yourself Lucky (CYL) to quantify the amount of times employees used the supplied safety technique [Stop, Think, Act, Review (STAR)]. Play it Safe, as a form of situational gaming and as a behavioral change support system (BCSS), through metaphorical re-contextualization attempts to create parameters for similar decision making encountered in the work environment and implicitly reinforce the training of the STAR protocol and conservative decision making. Play it Safe aims to improve employees’ situational awareness, creating a shared mental model and bottom–up accountability, meant to improve and align (shared) safety behaviors.