ARE DIGITAL GAMES A POTENTIAL

METHOD TO PROMOTE CHILDREN'S

HEALTH?

Heidi Parisod

MHSc, Doctoral candidate

Department of Nursing Science

University of Turku, Finland

CONTENT OF THE LECTURE

• Definition of health game

• Different possibilities of health games in children’s health promotion

• The advantages and limitations of health games

• Issues to be noticed when using or recommending health games for

children

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WHAT IS A HEALTH GAME?

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DEFINITION OF A ’GAME’

• There are many different variations of the definition of the

word “game”

• Most of the definitions defines game as an activity that

involves different components:

1) Players who are willing to participate the game

voluntarily and make choices in the game based

on the illusion of free will

2) Rules which define the limits of the game

3) Goals which give arise competition and conlicts

among the players

4) Games aim to be entertaining and fun

• A game that does not succeed in this is still a game

Adams 2010; Smed & Hakonen 2003; Suits 1967

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GAME ELEMENTS

• Avatar/game characters

• Playful presentation

• Scores

• Awards

• Badges

• Scoreboard

• Challenges

• Opponents

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GAME GENRES

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GAMIFICATION

• Game elements (the use of game thinking and game

mechanics) can be used also in non-game context

= gamification

• The purpose is to utilize the elements that make

games interesting

• The goal of gamification is to engage and motivate users in

different kinds of tasks

• For example to do physical exercise, learn

something, improve quality of work etc…

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Deterding et al. 2011

SERIOUS GAMES

• The game are usually used for entertainment, but games can be developed

and used for serious purposes as well

• A serious game can still be fun!

Adams 2010; Susi et al. 2007; Djaouti et

al. 2011

Can be used for serious purposes as

well

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HEALTH GAMES

• Health games are games developed and/or used for

different kind of health related purposes

• For example for health promotion, disease

prevention, disease management or rehabilitation

• Entertaining games (such as active video games) can be

called as health games if used for example for promoting

physical activity

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IN WHICH CONTEXT HEALTH GAMES CAN BE

USED?

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HEALTH GAME TYPES

• Educational games (e.g., informing users about a disease) 24,1%

• Behavioral games (e.g., improving adherence to medication) 27,5%

• Cognitive games (e.g., memory training) 3,3%

• Exercise games (e.g., improving physical exercise) 27,5%

• Rehab games (e.g., rehabilitation of upper extremity) 29,5 %

• Hybrid games (i.e., a mix of others) 12,0%

Kharrazi et al. 2012

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CLINICAL AND HEALTH CONTEXTS

• Most general clinical and health contexts of the health game

studies before 2011 (age groups 3-97 years)

Kharrazi et al. 2012

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EXAMPLES OF HEALTH GAMES

• A simulation game was used in 5-18

years old patients with burn injuries

successfully to reduce anxiety and pain

caused during painful medical procedures (Das et al. 2005)

• Guitar Hero game that requires manual

dexterity was used to support

rehabilitation after hand surgery

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• Glucoboy, a game developed for monitoring

blood glucose levels, promoted children’s

commitment for treatment and made the daily

monitoring fun for them

• Escape from Diab game has been used to

motivate children and adolescents to learn

about health habits that prevent diabetes and to

promote these habits with the use of a story,

game characters and different tasks in the

game that require problem solving

www.escapefromdiab.com/

Glucoboy

WHY TO USE GAMES?

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BENEFITS OF GAMES IN HEALTH PROMOTION

• Playing games is popular

• Games are played regardless of age, gender and

background

• Altogether about 97% of adolescents aged 10-19 years

reported playing computer, Internet, mobile or console

games (in 2010)

• 50% of adolecents reported playing games ”yesterday”

• The game play of young children is increasing and

playing games is also started at a younger age than

before Lenhart et al. 2008; Kuronen & Koskimaa 2011; Suoninen 2013

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OTHER

BENEFICIAL

ELEMENTS OF

GAMES

Parisod et al. 2014b

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• In children (3-18 years old) evidence seems to support:

• Active video games to have an increase in physical activity

to light to moderate levels and energy expenditure

• However, active video games cannot be recommended only for

meeting daily physical activity recommendations

• Educational/behavioral health games’ potential in supporting

changes in asthma- and diabetes-related behavior and in

dietary habits, but more research is still needed

SCIENTIFIC EVIDENCE OF THE HEALTH

OUTCOMES

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Examples of other positive

outcomes:

• Adherence to medication or

other treatment

• Change in attitudes

• Health related knowledge

• Change in symptoms

• Medical visits/school absence

• Cognitive skill development

• Improved communication

• Health behavior change

• Understanding negative

effects

• Health-related motivation

• Motor skill development

• Improved balance

• Improved hand-eye

coordinaton

• Perceived competence in

sport

• Reaching psychotherapeutic

goals

• Self-efficacy

• Self-esteem

• Self-management/skills/self-

care

• Decrease in pain and anxiety

Das et al. 2005; Parisod et al. 2014a; Peng ym. 2011; Barnett ym. 2011; Biddiss & Irwin 2010; Dayle 2009; Papastergiou 2009;

Guy ym. 2011; Peng ym. 2012; Leblanc ym. 2013

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IS THERE ANY LIMITATIONS?

OR SOMETHING OTHER TO BE NOTICED?

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HARMFUL CONTENT

• The content of health games should be based on scientifically

proofed and theoretical knowledge of the targeted health issue

and health promotion to achieve the desired outcomes

• The game should also meet the needs of the target group

• Carelessly designed content may lead to no effect or even

undesirable outcomes

• Aggressive content has been associated with aggressive behavior

although studies on this are conflicting

• Some content in digital media have been connected to negative

changes in sexual behavior (sexual beliefs and early sexual

initiation), substance use (alcohol, tobacco and drug use), and

body image

Parisod et al. 2014b Parisod 2015

PHYSICAL INACTIVITY

• Playing sedentary games increase physical inactiveness

• The amount of time spent using digital devices should not

exceed 2 hours per day in school aged children according to

the recommendations (Ministry of Education and Culture & Nuori Suomi Association

2008)

• The use of virtual environments is recommended only

occasionally in children up to 4 years of age and at most a

quarter of an hour every three days in children aged 4 to 6

years old from the developmental perspective (Delfos 2013)

-> Also educational health games could be designed so that the

game play requires physical activity of the player

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EXCESSIVE USE AND GAME ADDICTION

• Immersion in games may lead to excessive use and even game

addiction

• Excessive amount of screen time has been associated with poor

school performance and learning difficulties, developmental

concerns (attention‐ deficit disorder, language delays) and other

negative health effects, such as sleeping problems and disorders (Strasburger et al. 2010)

• Social interaction through digital devices may compensate real life

social connections and reduce engagement in real life social

connections and participation (van Rooij et al. 2010)

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• Most of the children have no problems with their game play,

but there is a small amount of players who use games so

excessively that it has an effect on their everyday life (=game

addiction)

• Game addiction may in a minority of cases lead to even similar

symptoms that are traditionally experienced in

substance‐related addictions (mood modification, tolerance

and salience) (Kuss & Griffiths 2012)

-> Some elements that limit the amount of health game play if

needed could be designed

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CYBERBULLYING AND HARRASMENT

• The social interaction in digital games offers a channel for

cyberbullying and other misuse such as sexual harassment

• Cyberbullying can be even more emotionally damaging than

face‐to‐face bullying

• Cyberbullying has been connected with depression, and in

extreme cases, with suicide attempts, and thus, needs to be

taken very seriously

-> Games can be designed so that it does not offer a platform for

inappropriate behavior, or a moderator could be included in the game

to prevent this misuse

Smith & Steffgen 2013; Willard 2005

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OTHER ISSUES TO BE NOTICED

• Equal accessibility

• Use of digital games can be restrained by the absence of ownership

and poor accessibility to digital devices or lack of needed skills for

technology use

• The game play can be also inaccessible because of some disability

such as visual impairment, but there are different possibilities in

game design that could be used to enable the equal game play of

children with different disabilities

• Information security

• Health related technology may interest also those with malicious

aims

• All health applications including any personal or health information

should be secured from different kind of cyber‐attacks

Barlet & Spohn 2012; Rauti et al. 2014 Parisod 2015

CONCLUSION?

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• There are many health and clinical contexts where

health games can be used, use imagination!

• Health games have potential in promoting

children’s health and they can make health related

issues fun for children

• Health games have clear advantages as health

promotion methods, but the limitations of games

should be also carefully considered

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EVALUATING HEALTH GAMES

• As the amount of good quality and freely available health

games is still fairly low

-> The health game needs to be carefully evaluated

before recommending it

• Is it possible to achieve the desired health outcome

with a game?

• What is the quality of the health game’s content and

designed mechanisms? Has it been evaluated?

• Is the game suitable for the target group? And does it

meet their needs?

• Have the game developers seeked to solve the

issues related to exessive game play and physical

inactivity, possibilities for harrasment, equal

accessability and information security?

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Thank you for your interest!

More information:

hemapar@utu.fi

www.ikitik.fi

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