Health 2.0 Games to Generate Data ChallengeFebruary 22, 2013

Team:Catherine Frederico, MS RD LDNLori OsieckiNicholas Doherty

GameStellar Health

Background SubstantiationCenters for Disease Control (CDC) statistics reveal a 67% percent adult obesity rate in America, with 17% of children being obese. The range of data from Mississippi and Colorado represent the highest and lowest obesity rate states. In 2011, the CDC’s national Behavioral Risk Factor Surveillance System study found them to be at 34.9% and 20.7%, respectively. A study by the Trust for America’s Health and the Robert Wood Johnson Foundation make obesity rate projections based on the current rate. The study projects that by 2030 Mississippi could have a 66.7% obesity rate, and Colorado would have the lowest at 44.8%.

Continuing on our country’s current obesity rate path is clearly not a desirable outcome, as obesity is the precursor to many chronic diseases listed by the CDC as: coronary heart disease, type 2 diabetes, cancers, hypertension, dyslipidemia, stroke, liver and gallbladder disease, sleep apnea and respiratory problems, osteoarthritis, gynecological problems of abnormal menses and infertility. Chronic kidney disease can also be consequence of diabetes or high blood pressure. Most of these illness are related to nutrition and fitness choices under our control.

Health professionals agree that obesity is a multifaceted problem that involves food intake, calorie expenditure, societal norms, and environments at home, work, and our communities. Learning preventative health strategies is key. A recent conference at Teacher’s College in New York City hosted by the new Laurie M Tisch Center for Food, Education and Policy asked community program administrators to speak about their successes and failures. Building trust, bottom-up strategies, empowering communities, evidence-based decisions, policy and zoning coordination, tax break incentives, urban farms, and health education to drive need were heralded as successful tactics. While collaboration was a primary theme, the panel also encouraged action that included sensitivity to need assessments and perceived need.

Health games are a fun and entertaining way to engage citizens in health education and practice decision making with the goal of having positive choice strategies in mind before being faced with momentary decisions on a host of areas that affect our health. Stellar Health is a game to engage players in personal and community health strategies.

Its game dynamic creates play paths to learn, discover, and practice making healthy choices using best practices from recent research.

Game Goals• To create a game to engage players in community and personal health using an Aligning Forces (AF) database(s) • To collect data for Aligning Forces (AF) databases• Engage players in learning and tracking personal and community health strategies• Reduce dollars spent on disease management by focusing on health education to drive need for disease prevention, as well as comparison shopping• Achieve personal and community health goals• Earn achievement rewards

Narrative Setting OverviewStellar Health is a long-play game set in a futuristic, interplanetary landscape that includes nine extensive activity stations.

represent the ten states included in the Aligning Forces databases: California, Ohio, Kansas, Maine, Massachusetts, Michigan, Minnesota, New Mexico, New York, Ohio, Oregon, Pennsylvania, and Wisconsin.

Orion and Carina are futuristic interplanetary health coaches that work for Stellar Health. Players choose their personal, colorful Navigation Bot. The health coaches and their companion Navigation Bots direct Stellar game citizens in exploring information about health and community features and policy that will help them make decisions based on their lifestyle wants and needs. They oversee the game’s databases and resource stations, while at the same time supporting players along their journey, collecting data from client and planet community searches and health care assessments and services. Navigation Bots shake and pop out numbers of spaces to move along the Star Path. Stellar currency is earned or spent in activities along the path to gain information to solve puzzles, surveys, and games at the Quizzer station. Activities include goal setting, information gathering, web quests, app play, and tracking. Players are periodically queried to reassess their goal settings and are rewarded for achievements.

Players experience health information discoveries, accomplishments, and setbacks along the Star Path. Accrued currency points can be spent on printable downloads such as certificates, bookmarks, achievement cards, and valuable handouts, as well as sponsor coupons in the Reward Galaxy. Offering commercial sponsorship opportunities to reputable firms focused on health is seen as a longterm strategy to offset game management costs and keep citizens interested in playing the game.

Game Dynamics• Stellar Health will be a game board created on a web platform with mobile functionality using a variety of game actions at the various play stations. Each station will link to its own page to further engage players.

• Players will be greeted by Stellar Health coaches Orion and Carina. • In preparation for Blast Off, players will set health status goals using a sliding scale.• Players then blast off into the game by clicking on Navigation Bots that guide moves to various stations. Players will be required to navigate the paths and stations of the virtual game board to complete activities from various selections to earn/lose currency points for rewards.

✴ Blast Off Center = set personal & community goal meter sliders; gain access to check in and assess progress ✴ Star Paths = A Navigation Bot will determine spaces to move. Spaces between activity stations will have pop-ups with instructions on moving forward, moving backward, or hovering to avoid astroids, meteors and various other health barriers, both real and fantasy.✴ Nutrition Missions = learn health information by participating in various activities; may include quests on other apps, websites, or real earthly places & establishments either individually or with others; learn about the US Dietary Guidelines, MyPlate, Food Tracker, Healthy People, nutrients, hydration, food labels, eating out, food deserts, farmer’s markets, how to find a dietitian in your area, etc; encourages an annual nutrition check-up by a registered dietitian ✴ Food 4 Thought = food and nutrition library resources; links to a Pinterest page of books and blog aggregator by registered dietitians; community food pantry links✴ Odyssey Town Hall = discover data about your town and use meter sliders to rank services that effect health governed by planning boards, health boards, zoning boards, recreation boards, school boards, and tax laws. Make observations about town transportation, pertinent services, and recreational opportunities. Connect with community officials via social media and websites.✴ Health Orbital = click the arrows to explore AF4Q and other pertinent galaxy databases and create tallies based on game play or observations. Players can choose a planetary county or state to explore information about its healthy living environment and services. Community/state rankings can be tallied based on information gathered during the game. Players will be encouraged to comparison shop and check insurance, Health Savings Accounts (HSA), Medicare, and Medicaid coverage for these services. Some financial assistance is known to exist for nutrition counseling for obesity, diabetes, and kidney disease. Link to healthcare.gov. Serve as citizen-scientists and document town services such as transportation, recreation, food, BMIs, health services, drug stores, etc✴ Power Up = learn about food science, healthy cooking, herbs and spices, calories, portions, phytonutrients, and foodie tips; take a grocery tour with a registered dietitian; get food myths busted; stock a pantry; stock a refrigerator and freezer; learn food safety; explore health apps library✴ Sky Gallery = import photos into the guided grid from mission quests; snap a picture of your plate or pantry; show a cup of pasta; find an organic package icon, picture of kale, etc

✴ Quizzer = test your health knowledge by puzzling your puzzler over situational choices and case studies, as well as match games, multiple choices, and raking games, etc; use the knowledge and data you find in the game stations✴ Play Space = learn about physical calorie expenditure for various activities; use the SuperTracker for physical activity, search for parks, join the President’s Challenge, plant a garden, track days of activity, learn about activity sensors, find a walking club; learn about exergames. Link to RWJF Health Games Research database. Create a play list. ✴ Reward Galaxy = tracks activity points. Earned points can be accrued and exchanged for achievement certificates, downloadables, and possibly coupons provided by sponsor partners. One (healthy) food sponsor has already expressed interest.

Databases and Links -- possibly including but not limited to:• AF4Q 16 community, (ten state) databases (1 required, but may use more)• County Health Rankings: http://www.countyhealthrankings.org/rankings/ranking-methods/download-rankings-data • America’s Health Rankings: http://www.americashealthrankings.org/ and associated databases• Behavioral Risk Factor Surveillance System (BRFSS): www.cdc.gov/brfss • USDA Food Environment Atlas: http://maps.ers.usda.gov/foodatlas • Centers for Disease Control: www.cdc.gov• US Census: www.census.gov• Academy of Nutrition and Dietetics: www.eatright.org• Farmer’s Markets: http://www.localharvest.org/farmers-markets/ and/or http://search.ams.usda.gov/farmersmarkets/ • Recipe Finder: http://recipefinder.nal.usda.gov/ • Food Safety: www.foodsafety.gov • Environmental Protection Agency: http://water.epa.gov/drink/local/ • Weather: www.climate.gov/#dataservices • Parks: http://www.nps.gov/findapark/index.htm • Let’s Move: www.letsmove.gov• ChooseMyPlate: www.choosemyplate.gov• SuperTracker: www.supertracker.usda.gov• Nutrition: www.nutrition.gov• Health Care: www.healthcare.gov • Healthy Dining Finder: www.healthydiningfinder.com• President’s Council on Fitness, Sports, and Nutrition: www.presidentschallenge.org • People’s Garden: http://www.usda.gov/wps/portal/usda/usdahome?navid=GARDEN_RT7&parentnav=PEOPLES_GARDEN&navtype=RT • Dietary Guidelines: www.dietaryguidelines.gov• Healthy People 2020: www.healthypeople.gov • State Public Health Departments: http://www.cdc.gov/mmwr/international/relres.html • Health and Human Services, Portion Distortion: http://hp2010.nhlbihin.net/portion/ • USDA Nutrient Database: http://ndb.nal.usda.gov/ndb/search/list

• SSNP (Special Supplemental Nutrition Program) for WIC: http://www.fns.usda.gov/wic/benefitsandservices/foodpkg.htm • SNAP (Supplemental Nutrition Assistance Program): http://www.fns.usda.gov/snap • Plant Hardiness: www.planthardiness.ars.usda.gov/PHZMWeb • Health Games Research: www.healthgamesresearch.org • Web and social media links to elected and community officials. www.senate.gov www.house.gov etc

Software and Technical PlanStellar Health is an ambitious, comprehensive game strategy that aims to simplify health education and complex health management for personal and community well-being. Programming the game will use a simple core plan to build each of the nine major game stations (web pages) that point to reputable resources and allow for securely tracking knowledge gained for assessment. It is fully expected that a basic foundation for each station will be built to accommodate future embellishment as needed.

The domain www.StellarHealthGame.com has been purchased. The game will be hosted on this site and point to a dedicated web server with mysql capable of running php and JavaScript, and storing the data. It will be made available in web and mobile format. Other than basic web links and functionality (eg, gif, excel), game software Dundjinni www.dundjinni.com and/or Unity http://unity3d.com/unity/ and/or http://craftyjs.com can be used. Graphic work will also be done using Adobe Creative Suites. Flash will be avoided to be able to function on all platforms.

Later, the app could possibly be built using Apple IOS for iPhone, iPad, and iPod Touch if desired. Phone Gap could be used to convert the game to other platforms including Android and Windows even with possible geolocation and barcode scanner capabilities.

Players 13 and over will anonymously register. Play goals, scores, and info tallies will be stored on a secure server. At the very least, a community excel chart can be posted using Google Fusion and Google Drive and could include resources posted by local citizens, and game progress. Achievements and rewards will be available using a leader board format, and later, Apple Game Center could possibly be incorporated on Apple platforms.

DeploymentStellar Health’s website could first be advertised to state public health associations as a free device to engage citizens. A kickoff at a major health conference (medical, nursing, nutrition, fitness), speaking engagement, or newsletter would be helpful. It would be of particular interest to those states included in the AF4Q databases.

Game availability announcements could also be circulated to:• American Public Health Association, www.apha.org• State Public Health Associations• National Association of Local Boards of Health; www.nalboh.org • Association of State and Territorial Health Officials; www.statepublichealth.org and

http://qcommerce.astho.org/PortalTools/Directory/StateHealth.cfm?Type=S&postbk=y • Centers for Disease Control, Game Division Director, approach for partnership• Academy of Nutrition and Dietetics’ Public Health Community Nutrition Practice Group; www.phcnpg.org • other AND Dietetic Practice Group listservs, newsletters, conferences; www.eatright.org ; approximately 30 groups• Games for Health listserv and annual meeting presentation• Association of Schools of Public Health; www.asph.org • Physical fitness, parenting, and aging (AARP) organizations• Be made into a facebook game• Twitter #StellarHealthGame• Youtube, Vimeo, television news• College campuses• Sorority and Fraternity competitions

In communities, game information could be disseminated to citizens through public health boards taking advantage of town websites, newspapers, mailings, town meetings, and cable stations. Colleges and universities that offer introductory nutrition courses could also use the game as an educational exercise. These courses are most often taught by registered dietitians who belong to an educational dietetic practice group. Communities could also develop intra or inter-group competitions.

Medical professionals in hospitals, clinics and schools could help promote the game and “prescribe” it to clients. Registered dietitians, nurses, doctors, social workers, and fitness professionals are well connected professionally and clinically. They would make great Stellar Health ambassadors by introducing the game to clients. Social services such as Women, Infants and Children (WIC, now SNPP) could also promote the game as an educational device to parents.

SummaryStellar Health is a comprehensive game that encourages players to engage and process a multitude of factors that effect health choices and decisions. Easy web and mobile access affords universal, ubiquitous play based on educational strategies and known data and data that is acquired. Learning about personal and community healthcare management by playing Stellar Health will hopefully result in citizens making enlightened, smarter decisions managing costs, chronic disease risk, and their health span.

Figure 1. Stellar Health Playing Board Concept

Figure 2. Blast Off Goal Slider Concept

Figure 3. Health Orbit Opening Page Concept

Figure 4. Navigation Bots

Figure 5. Bot Dice