Since 2010, both sites have hosted challenges sponsored by organizations, corporations, and the government. Some have monetary prizes, some just offer recognition. The goal is to bring software programmers, designers, and health care experts  together for rapid application development. There are two types of developer projects: 1) challenges, which overseas team collaboration to build specific requested tech solutions, and 2) code-a-thons.  Code-a-thons are typically one day or weekend events that spur teams to rapidly create new applications and tools to improve health care.

Health 2.0 and Challenge Post make it easy to form teams with their community boards and resources. Check out the wide array of challenges posted on their sites. Compare goals, deadlines and prizes. Make new contacts, enjoy the thrill of creativity, and the pride of helping find real solutions to health care issues. Several have December 31, 2011 deadlines, so check out the fun and competition, and register today!

http://www.Health2Challenge.org
http://www.Challenge.gov

James Watt, PhD is a serious games researcher at the University of Connecticut. He explains that social interaction is relative to masked identity. Group communication is best when there is also social interaction. So how about creating an avatar-likeness with body movements that still provides anonymity? Microsoft Xbox recently released Avatar Kinect that scans participants and then creates a general look-alike avatar of themselves – including body movements.

Players might not mind sharing personal attributes with friends, but would players feel comfortable revealing their size, hair color, and mannerisms to strangers, too? This remains to be seen, as medical professionals brainstorm about health applications. Consider in-home avatar group therapy sessions, patient education classes, addiction support groups, or parent clubs. Now layer on a health gaming twist. How about a virtually engaging game of Nutrition Jeopardy? The possibilities are tremendous! What kind of avatar health games do you envision? This field is wide-open for development. Game on!

Similar to the DIVERSE Conference call for eHealth papers, this is a great opportunity for those of you with experience in games for health research to step up to the plate and get your knowledge in print.

What you need to know.

Below is a summary of the general needs:

• Book objectives: To introduce the development and application of game technologies for health-related serious games; to provide cutting edge research from academia and industry, informing readers about the current and future advances in the area.
• Target audience: Innovative professionals and researchers in healthcare.
• Recommended topics: Key trends of serious games for health; design and development; future trends of serious games for health.

How to submit.

Researchers and practitioners are invited to submit on or before April 15, 2011, a 1-2 page chapter proposal clearly explaining the mission and concerns of his or her proposed chapter. Visit the Serious Games for Healthcare: Applications and Implications for full details about the requirements. Inquiries and submissions can be forwarded electronically (Word document):

Dr. Sylvester Arnab
Serious Games Institute
Coventry University
CV1 2TL, UK
Tel.: +44(0)24 7615 8205
E-mail: s.arnab[at]coventry.ac.uk

The latest issue of the Journal of Diabetes Science and Technology was just released, and it includes a special section summarizing all the talks given at the NIH-sponsored Virtual Reality Technologies for Research and Education in Obesity and Diabetes Symposium.

During this meeting, researchers gathered in Bethesda, Maryland to “explore the potential of VR technologies for behavioral and neuroscience studies in diabetes and obesity, and the practical potential of VR technologies for regimen adherence, nutrition, physical activity and other behavioral lifestyle changes associated with diabetes and obesity.”

The publications.

Here are just a few of the things you will learn in this month’s issue:

• Behavioral Science in Video Games for Children’s Diet and Physical Activity Change: Key Research Needs  read now
• Turning Virtual Reality into Reality: A Checklist to Ensure Virtual Reality Studies of Eating Behavior and Physical Activity Parallel the Real World  read now
• What Virtual Reality Research in Addictions Can Tell Us about the Future of Obesity Assessment and Treatment  read now
• The Key to Unlocking the Virtual Body: Virtual Reality in the Treatment of Obesity and Eating Disorders read now
• New Directions in the Use of Virtual Reality for Food Shopping: Marketing and Education Perspectives  read now
• The Potential of Virtual Reality Technologies to Improve Adherence to Weight Loss Behaviors and Outcomes  read now

In summary, if you want to learn about how virtual gaming and virtual worlds are being used to research, treat, prevent, and educate about diabetes and obesity, the March 2011 issue of J Diabetes Sci Technol is for you.  Enjoy!

The methods.

A study was conducted with 327 high school teachers in 40 states to assess the effectiveness of the program. The study used a quasi-experimental design with an experimental and control groups. The experimental group completed the At-Risk training and then responded to the questionnaire while the control group only completed the questionnaire.

The results.

The results were statistically significant at p<0.01 levels in all independent variables that were measured. Teachers who completed the training reported statistically significant increases in their ability to identify, approach, and refer at-risk students. Teachers also reported an increase in the likelihood that they would approach and refer an at-risk student. Here are some of the particularly interesting figures:

1. 97% of teachers recognize that part of their role is to identify and refer at-risk students.
2. 97% of participants who received the training indicated they were likely or very likely to approach and refer an at-risk student.
3. 96% of participants reported that engaging in simulated conversations with at-risk students was helpful in preparing them for similar conversations in real life.
4. 89% rated the course as Very Good or Excellent.

The future.

At-Risk is one of the few mental health games that deals with suicide prevention. Other examples include Beyond the Front for the U.S. Army and Reach Out Central created by Inspire Foundation, Australia.  The results of this new At-Risk study show that mental health game technology can be a powerful tool in school settings–where most at-risk youth spend the majority of their day. You can read more about Kognito Interactive’s research by visiting their website at http://www.kognito.com/atrisk/research.html. Congratulations to the Kognito Interactive team!

I have never met Dr. Joseph C. Kvedar of Partners HealthCare’s Center for Connected Health, Susannah Fox of Pew Research Center’s Internet and American Life Project, or Professor Andy Clark of Edinburgh University face to face in the real world. And yet they have all profoundly changed the way I think about health care’s most vexing problem: how are we going to take care of all these Baby Boomers who are starting to retire and get sick?

Kvedar nicely summarizes this supply and demand problem on one slide in a talk I watched on YouTube; he notes that there are currently 24 million Americans with diabetes, and the rate is increasing 8% every year. One in three Americans over 20 years old have hypertension, and Kvedar wonders where we are going to get all the doctors to care for these patients. His answer is we need to form trusting relationships with technology in a process he terms Emotional Automation.

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I had never heard of Kvedar or the Center for Connected Health until I saw a Fox Twitter link to her blog post about robots, enchanted objects, and networks.  Fox and I follow each other on Twitter, so I read her blog, which included the embedded YouTube video of Kvedar speaking about Emotional Automation. In a way Fox is also responsible for me knowing about Professor Clark’s views on “embodied cognition” and “the extended mind.” One Sunday Fox noted in a tweet that my habit of aggregating the health care news every morning at 5:30 AM was helpful to her and the rest of my twitter tribe. That one pat on the back encouraged me months later to scour the New York Times blogs where I found Professor Clark’s Opinionator blog titled “Out of Our Brains.”

Can technology really solve the supply and demand problem in American health care? Can humans love and trust electronic devices made of glass, silicon and plastic? What can video games teach us about changing behaviors to cope with chronic disease? Should we think about what the explosion of cognitive prosthetics means for our understanding of the interplay between brains, bodies, and the real world where we live?

Our loving relationship with technology.

Many of us have already formed trusting, loving relationships with technology, but we have not really thought through the implications for health care. People love and trust their iPhones and tablet computers because they are extensions of themselves. “It is different now that we carry our second self with us. We think with the objects we love and we love the objects we think with.”

So says MIT’s Sherry Turkle, the pioneering student of evocative subjects. Mark Rolston, chief creative officer of Frog Design, observes that people grieve when they lose a personal electronic device. “You are leaving your brain behind,” he says. I have blogged before about Lois Simmeth, 73, who lives in a Pittsburgh nursing home that provides her with a $6,000 harp seal robot to hold. “I love animals. I know you’re not real but somehow, I don’t know, I love you.” Kvedar observes that humans find it easy and natural to anthropomorphize pet rocks and Tamagotchis. He also states that most of us initially believe that a trusting relationship requires two human beings who interact face to face in the real world.

Philosopher Roger Scruton is not buying my argument that trusting relationships with technology are possible:

“In real life, friendship involves risk. The reward is great: help in times of need, joy in times of celebration. But the cost is also great: self-sacrifice, accountability, the risk of embarrassment and anger, the effort of wining another’s trust. Hence I can become friends with you only by seeking your company. I must attend to your words, gestures and body language, and win the trust of the person revealed in them, and this is risky business…. When I relate to you through the screen there is a marked shift in emphasis. Now I have my finger on the button. At any moment I can turn you off…Of course I may stay glued to the screen. Nevertheless, it is a screen that I am glued to, not the person behind it.”

Tom Chatfield and I are betting Scruton is not addicted to World of Warcraft or WoW as it is fondly called by its 12 million monthly subscribers who pay over $1 billion annually to play this Massively Multiplayer Online (MMO) video game. Chatfield in his book Fun Inc.: Why Gaming Will Dominate the Twenty-First Century (New York: Pegasus Books, 2010) describes the WoW social experience as friendly and accessible to both beginners and experts. The story of how Adam Brouwer’s orc warrior Mogwai after 4,500 hours of play became the leader of the guild Adelante with 20,000 gold pieces and the two most powerful weapons in WoW is instructive for those of us who do not play MMO games. Although Brouwer thinks he could sell Mogwai for $10,000 on e-Bay for real world money, his obligations and allegiances to his fellow players won’t allow him to cash out. “The strange thing about Mogwai is that he doesn’t just belong to me. Every item he has got through the hard work of twenty or more other people. Selling him would be a slap in their faces. When I started, I didn’t care about the other people. Now they are the only reason I continue.” (Chatfield)

What video games can teach us about human behavior.

Video games have much to teach us about how to motivate humans to self manage their chronic diseases, and they offer a research tool for large-scale studies of human behavior. Researchers are interested in why video gamers become so absorbed and focused and are able to easily achieve the state of flow usually associated with master musicians and champion athletes. “Gamers are engaged, focused, and happy. How many employers wish they could say that about even a tenth of their work force?” says Edward Castronova of Indiana University. How many doctors wish they could say that about a tenth of their patients managing their chronic illness? A recent Harvard Business Review article concluded “the best sign that someone’s qualified to run an Internet startup may not be an MBA degree, but level 70 guild leader status” in a MMO video game. (Chatfield)

Nicole Lazzaro of the player experience and research company XEODesign has identified four key characteristics of video games that may help explain why the typical American has spent 10,000 hours playing computer games by the age of 21.

1. “Hard fun” entails pursuing a goal that gets more difficult with each level of play and requires the player to use sophisticated strategies and be rewarded for progress.
2. “Easy fun” entails sheer enjoyment of the game and satisfying the player’s need for curiosity and mystery.
3. “Altered states” refers to player reports that video games changed how they felt inside by clearing the mind, eliminating boredom, changing their sense of time, and experiencing a sense of achievement.
4. “The people factor” is important to gamers because they develop relationships with others. Remote interactions with fellow players from all over the world are increasingly taking place through microphones, speakers, and real time conversations as well as in-game interactions. (Chatfield)

Using games to change patients.

These learnings from video games can and are being incorporated into strategies to motivate patients to change behaviors to prevent and live with chronic disease conditions.

Managing a chronic condition is full of failures manifested by high blood sugars and unexpected increases in body weight. Chatfield believes “One of the most profound transformations we can learn from games is how to turn the sense that someone has ‘failed’ into the sense that they ‘haven’t succeeded yet.’” Carnegie Mellon University’s Jesse Schell has described a system of awarding points for everything we do in real life in order to reward healthy behaviors. Lucy Bradshaw of Maxis explains, “You could strive to get the 10-stroke tooth brushing achievement, for instance, and then somehow you would collect all those points and utilize them.” Dr. Jane McGonigal of the Institute For The Future plays the online Chore Wars game in which she and her husband earn real rewards by doing chores in their San Francisco apartment. Anne McLaughlin of North Carolina State University’s Gains Through Gaming Lab says, “To make something into a game, you have to have a goal. You have to create the game. It’s more than just measurement…I know we keep talking about blurring the lines between gaming and reality, but I think it does that, and when it’s for a good cause it’s great.” While some think this is great, even the moderator of the South by Southwest Interactive Festival found it “rather ominous and spooky.”

Video games also offer a research tool for understanding the real time interactions of complex systems involving people. Emergency triage and epidemic management are just two areas where game theory can reproduce complex systems and try out different strategies. Blitz Game Studios is developing a triage game that takes place in an interactive three-dimensional world. One physician favorably compared this approach to the traditional large-scale emergency training with volunteers covered with fake blood. “A virtual world can simulate the noise, the chaos, everything. You could assess, for example, the exact percentage and degree of someone’s burns from the way they looked in a game.” Most importantly such a game allows participants to try out different approaches and see if they work. Epidemiologist Nina H. Fefferman at the 2008 Games for Health Conference stated that studying thousands of people in games could model the unpredictable human behavior in epidemics. (Chatfield) Castronova says, “One reason that policy keeps screwing up – think Katrina – is because it never gets tested. In the real world, you can’t create five versions of New Orleans and throw five hurricanes at them to test different logistics. But you can do that in virtual environments.” Chatfield observes, “Game technologies excel at nothing so much as scoring, comparing and rewarding progress.”

Therapists are now using digital worlds with autonomous, virtual humans to help patients work through social anxiety, drinking, gambling, post-traumatic stress, and agoraphobia. Such therapists can discuss the patient’s feelings at the very moment that the virtual bartender asks the alcoholic if he wants to order another drink, and different coping techniques can be practiced time and time again in virtual situations that are experienced as real. One such patient said, “I just think it’s a fantastic idea to be able to experience situations where you know that the worst cannot happen. You know it’s controlled and gradual and yet feels somehow real…the great thing about it [is]…you get to practice.” USC psychologist Albert Rizzo has helped veterans with post-traumatic stress by using a virtual Humvee scenario that recreates ambushes by insurgents. “We can control the intensity of experience, and then work on the patient’s response,” breaking the association between reminders of the ambush and the panic the patient has been dealing with months later. In a USC study, people with social anxiety confessed more of their personal flaws, fears and fantasies to virtual figures programmed to be socially sensitive than to live therapists conducting video interviews.

Kvedar, who first introduced me to the concept of Emotional Automation, cites Karen the virtual wellness coach/avatar who gets her human walkers to exercise more and the Boston hospital patients who prefer a robot discharge planner to a human one as examples of humans learning to trust technology. And why shouldn’t the patient prefer the robot that is not in a hurry, does not talk down to the patient, and encourages the patient to ask the same question over and over again. The busy human discharge planner may in this setting be less effective than the avatar.

The term avatar comes from Sanskrit and is usually translated as incarnation or descent to describe the process in which a higher spiritual being (Rama or Krishna, for example) takes on mortal flesh. It is now commonly used to describe a player’s presence within a video game. (Chatfield) Palo Alto Research Scientist Nick Yee, PhD has described the Proteus Effect, how our video game avatars change how we behave in virtual environments and in real life. In several papers, Yee demonstrated that players given more attractive or taller avatars disclosed more personal information and bargained more aggressively than unattractive, shorter avatars. Yee also showed that the person’s perceptions of their own attractiveness persisted outside of the game environment to affect their participation in real life online dating. Yee believes that providing users with “fit, athletic avatars in exergames may encourage longer and more engaged exercise sessions than if they were provided with normal-looking avatars or avatars that were modeled from their own bodies.”

Games, brains, bodies, and the real world.

Finally, what does all this do for our understanding of the interplay between brains, bodies, and the real world where we live? Professor Clark who works in “embodied cognition” and “the extended mind” fields of philosophy argues that a wire-free interface that links our brains to our notepad or iPhone should count as providing support for our cognitive processing. Basically, I think he is saying that some of the activity that enables us to think occurs outside of our brain. He cites studies that show that hand gestures may play an active role in our ability to think; when research subjects were prevented from using hand gestures, they perform poorly on tests of mental abilities. He provocatively notes “evolution and learning don’t give a jot what resources are used to solve a problem. There is no more reason, from the perspective of evolution or learning, to favor the use of a brain-only cognitive strategy than there is to favor the use of canny (but messy, complex, hard-to-understand) combinations of brain, body, and world.”

I have never spoken to Kvedar, Fox, or Clark face to face in real life, and yet they have indirectly convinced me that patients in the future will trust and use technology to prevent and treat illness in ways that we are just starting to understand and envision. The supply and demand problem of taking care of retiring Baby Boomers will include robots, avatars, video games, and physicians.

American Journal of Preventative Medicine, Elsevier: San Diego, CA, December 7, 2010 – Obesity in youngsters has risen dramatically in recent decades. Fruit and vegetable (FV) consumption and increased water intake can lower the risk of obesity, as can increased physical activity, but it is not always easy to convince children to eat better and exercise more. In a new study published in the January 2011 issue of the American Journal of Preventive Medicine, researchers found that video games designed to encourage these behaviors were effective.

About the games

“Escape from Diab” (Diab) and “Nanoswarm: Invasion from Inner Space” (Nanoswarm) are epic video games specifically designed to lower risks of type 2 diabetes and obesity by changing youth diet and physical activity behaviors. Designed by Archimage, Inc., and funded by a Small Business Initiative Research Grant from the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health, Diab and Nanoswarm are based on social cognitive, self-determination, and persuasion theories.

“Diab and Nanoswarm were designed as epic video game adventures, comparable to commercial quality video games. These games incorporated a broad diversity of behavior change procedures woven in and around engrossing stories. The games motivated players to substantially improve diet behaviors,” according to lead investigator Tom Baranowski, PhD, Professor of Pediatrics, U.S. Department of Agriculture/Agricultural Research Service supported Children’s Nutrition Research Center, Baylor College of Medicine. “Serious video games hold promise, but their effectiveness and mechanisms of change among youth need to be more thoroughly investigated.”

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The study and results

Children playing these video games increased FV consumption by about 2/3 serving per day, but did not increase water consumption or moderate to vigorous physical activity, or improve body composition. Despite the increase, FV and water consumption and physical activity remained below the minimum recommendations.

In this randomized clinical trial, 153 children ages 10 to 12 years, were divided into a treatment group (103 children) and a control group (50). Complete data were obtained on 133 subjects. The treatment group first played Diab and then Nanoswarm. The control group played diet and physical-activity knowledge-based games on popular websites. Each group was assessed at the start of the trial, immediately after Diab, immediately after Nanoswarm, and again two months later. Height, weight, waist size, and triceps skin-fold thickness were measured. Physical activity was monitored for at least 4 days by accelerometer-based data from each child at each assessment. Food consumption was measured using 24 hour dietary recalls conducted by registered dietitians.

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The article is “Video Game Play, Child Diet, and Physical Activity Behavior Change – A Randomized Clinical Trial” by Tom Baranowski, PhD, Janice Baranowski, MPH, RD, Debbe Thompson, PhD, Richard Buday, FAIA, Russ Jago, PhD, Melissa Juliano Griffith, MPH, Noemi Islam, MPH, Nga Nguyen, MS, and Kathleen B. Watson, PhD. It appears in the American Journal of Preventive Medicine, Volume 40, Issue 1 (January 2011) published by Elsevier. doi: 10.1016/j.amepre.2010.09.029

One of the tracks during the conference was focused on health gaming which included contributions from pioneer Ben Sawyer, President of Digital Mill and Games for Health conference founder. Pixels and Pills — one of the leading blogs on the pharma industry and digital media, caught up with one of the speakers at the games for health track to get an idea on what exergaming is and how it can be helpful.

Elizabeth Lyons of UNC Chapel Hill explains where exergaming can be helpful in weight maintenance and prevention of weight gain but where it will be necessary to include other initiatives to truly bring about healthy behavior changes:

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Exergaming

There have been several product launches of exergames, mainly sports games, combining real exercise and a display screen. Melanie Lazarus has recently posted on healthGAMERS an exhaustive chronology of exergames.  Even though some of these games could be categorized as memorable flops to be taught in MBA marketing courses, all have two elements in common:

1. Putting the player “in the game” and
2. Taking a typical outdoor activity and bringing it indoors by requiring the player to connect with technology.

A scientific article published almost three years ago in the British Medical Journal pointed out that the energy used when playing active Wii Sports games is not of high enough intensity to contribute towards the recommended daily amount of exercise in children. It is therefore interesting to solve this equation of videogaming and exercise and to figure out how kids can burn calories without playing only exergames.

Physical Activity Monitoring

It is possible to imagine that a player or his parents could report on the computer real exercise performed in real life. Such monitoring can then be coupled to a lock/unlock game function which takes into account the amount of calories spent. You can then convert these spent calories in game time, next level access, bonuses and extra points.  In fact, this already exists.  For example, HopeLab has created Zamzee that should be available in 2011,  an online rewards system powered by physical activity recorded through an activity meter.

It is also possible to imagine that games could be used as a reward for physical activity in the real world. Imagine a fat Mario with limited power which can be improved by the amount of burnt calories of the player. The access and the use of video games is therefore controlled by the level of recorded physical activity. Again, as for example, iToys, a major Canadian toy industry actor, has created Me2, a hand-held activity meter device which is already sold on Amazon. When plugged into a computer, the device transfers the activity recorded into a 3D game that powers the gamer’s avatar.

Human-Generated Energy

In order to include players who never play sports games, some ingenuous systems have been conceived including the pedal-powered laptop developed by the MIT students. The player has to generate sufficient energy to charge the computer or to keep it turned on.

Indeed, Motion Fitness, an Illinois based company, already sells a similar system, “Brain Bike,” which was developed by a team of neuropsychologists and medical specialists. It relies on the Neuroactive® brain-fitness program that improves cognition while pedaling. The computer is connected to a module called Gamercize which interacts with the BrainBike by activating the mouse when pedaling then stopping the mouse when pedaling stops.

Furthermore, Humana Games, a subsidiary of HMO company Humana, has created the “Horsepower Challenge,” an online game that motivates physical activity in school-aged children. Each student wears a pedometer on his or her shoe which stores data and wirelessly uploads it to a website. When an individual accesses the site, the player is represented by a horse avatar. Steps can then be collected for an entire school. The students’ steps power a virtual school bus on a race around the world, which pauses for brief history lessons on historic landmarks along the way.

Alternate Reality Gaming

Augmented reality technologies bring a whole new way of gaming. It offers the possibility to play and interact with the outdoor environment in real-time.  For example, Hidden Park, available on the App Store, is a GPS adventure game for the iPhone. The game is played while visiting parks all around the world and uses alternate reality and geo-caching to create a fantasy world with digital photographs taken by the player. By the end of the day, the player has an album of their adventures, and they can compete or share their experience with others in the gaming community.

As a projection in the very near future, HP has created “Roku’s Reward” a demo game for their Tablet PC. HP says that they are not currently developing the game, however, the technology seems to be mature enough to consider the development of such a game in the near future.

Conclusions

I believe we are at the very beginning of understanding how these new technologies could be used in the most efficient way to help kids spend their extra calories because trying to prevent them of playing video games is already a lost battle. With the development of Human Generated Power and augmented reality technologies, there will be a huge body of possibilities to create new and highly interactive videogames that might help reduce obesity in children and increase physical activity.

Currently, ROC gamers encounter situations designed to help them make new friends and handle peer pressure, stress, and anxiety in healthy ways. They learn about self-confidence and anger management as well as strategies to apply in situations that encourage drug use.

While researchers are still administering online surveys to collect more information, data from the Swinburne University eTherapy Unit’s evaluation is available for review. This evaluation is presented and analyzed by Kerrie Shandley and two other faculty members from the Swinburne University of Technology.

Purpose of ROC

The designers of ROC intended to use cognitive-behavioral principles to assist young people in the identification and development of practical coping skills for dealing with life stressors that might otherwise contribute to the development of mental health problems.

The game also has a mood component that must be increased to promote easier progress, so ROC is both preventative and therapeutic in terms of mental health.

Role-play encourages gamers to both learn life skills for good mental health and apply them offline. Skills like problem-solving, challenging negative beliefs, and negotiating relationships are emphasized in the game.

Gamer Responses to ROC

A qualitative survey was administered to ROC participants four weeks after a trial version of the game was released. The survey consisted of only two questions and encouraged gamers to select at least one pre-scripted response to each question, but also included a text box for open comments. 154 ROC players were asked to identify what they liked most about the game and what they liked least about it.

• Game play, which was described on the survey as including interactivity, response options, choices, storyline, characters, and fun, was identified by 44.8% of players as the best part of ROC. Other top aspects of ROC included informative and educational components (31.2%); game design components like interface, music, and graphics (26%); and the realistic and relatable nature of the game (19.5%).
• The characteristic of ROC that players identified as being the least satisfactory was its usability at 36.4%.  58.9% of gamers who wanted to see improved usability cited technical issues (such as navigation, bugs, screen resolution, accessing the website, and logging in) as the worst problems, while the remaining 41.1% experienced difficulty with instructions, directions, and objectives.
• Interestingly, the runner-up for least favorite aspect of ROC was game play, which was selected as the best thing about the game. 27.9% of players found game play to be deficient in terms of storyline, length of the game (too short), response options, pace (too slow), and number of locations and scenarios (too limited).

Recommendations for Future Mental Health Games

Based on the responses collected thus far from ROC gamers, Shandley and her team have developed a list of considerations for future mental health game designers who want to focus on preventative and therapeutic components.

• Keep uploads and downloads to a minimum and limit updates as much as possible.
• Allow gamers to customize their experiences as much as possible in order to give them a heightened sense of control and increased identification with characters.
• Make sure that directions and objectives are clear. One specific way to do this is to ensure that players know when an objective has been completed, leaving no doubts about what to do next. This also gives players a sense of accomplishment.
• Debug the game as much as possible prior to its release. With serious games, the stakes are higher, and bugs can influence players to quit without giving it a second thought. To make sure that everyone who wants to learn from the game can enjoy it, debugging is an essential priority.

About the Author

Alexis Bonari is a freelance writer and blog junkie. She is currently a resident blogger at First in Education performing research surrounding online universities and their various program offerings. In her spare time, she enjoys square-foot gardening, swimming, and avoiding her laptop.