Background: Serious games for health have been gaining in popularity among scholars and practitioners. However, there remain a few questions to be addressed. Objective: This study tests the effects of a serious game and fear appeals on smoking-related outcomes. More specifically, this research aims to understand how serious games function as a more effective vehicle for a health campaign than a traditional medium, such as a print-based pamphlet. Further, while serious games utilize a variety of persuasive strategies in the game’s content, it is not clear whether fear appeals, which are widely used persuasive-message strategies for health, can be an effective strategy in serious games. Thus, we are testing the effect of fear appeals in a serious game. Methods: We created a computer game and a print brochure to educate participants about the risks of smoking. More specifically, a flash-based single-player game was developed in which players were asked to avoid cigarettes in the gameplay context. We also developed an online brochure based on existing smoking-related brochures at a university health center; antismoking messages on the computer game and in the brochure were comparable. Then, an experiment using a 2 (media type: game vs. print) x 2 (fearful image: fear vs. no-fear) between-subjects design was conducted. The study recruitment was announced to undergraduate students enrolled in a large, public Midwestern university in the United States. After a screening test, a total of 72 smokers, who reported smoking in the past 30 days, participated in the experiment. Results: Overall, gameplay, when compared to print-based pamphlets, had greater impacts on attitudes toward smoking and the intention to quit smoking. Further, the game’s persuasive effects were especially pronounced when messages contained fear appeals. When fearful images were presented, participants in the game condition reported significantly more negative attitudes toward social smoking than those in the print condition [F(1,67)=7.28; P=.009; ηp2=0.10]. However, in the no-fear condition, there was no significant difference between the conditions [F(1,67)=0.25; P=.620]. Similarly, the intention to quit smoking [F(1,67)=4.64; P=.035; ηp2=0.07] and susceptibility [F(1,67)=6.92; P=.011; ηp2=0.09] were also significantly different between the conditions, but only when fear appeals were used. Conclusions: This study extends fear appeal research by investigating the effects of different media types. It offers empirical evidence that a serious game can be an effective vehicle for fear appeals.

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Background: Serious games enrich simulation-based health care trainings and improve knowledge, skills, and self-confidence of learners while entertaining them. Objective: A platform which can combine performance data from a basic life support (BLS) serious game app and hands-on data based on the same scoring system is not available in the market. The aim of this study was to create such a platform and investigate whether performance evaluation of BLS trainings would be more objective compared to conventional Objective Structured Clinical Examination (OSCE) examinations if these evaluations were carried out with the platform which combines OSCE scoring criteria with sensor data retrieved from the simulator’s sensors. Methods: Participants were 25 volunteers (11 men [44.0%] and 14 [56.0] women) among Acıbadem Mehmet Ali Aydınlar University students without prior knowledge of the BLS protocol. A serious game module has been created for teaching learners the European Resuscitation Council Basic Life Support 2015 protocol. A second module called the hands-on module was designed for educators. This module includes a checklist used for BLS OSCE examinations and can retrieve sensor data such as compression depth, compression frequency, and ventilation volume from the manikin (CPR Lilly; 3B Scientific GmbH) via Bluetooth. Data retrieved from the sensors of the manikin enable educators to evaluate learners in a more objective way. Performance data retrieved from the serious gaming module have been combined with the results of the hands-on module. Data acquired from the hands-on module have also been compared with the results of conventional OSCE scores of the participants, which were obtained by watching the videos of the same trainings. Results: Participants were considered successful in the game if they scored 80/100 or above. Overall, participants scored 80 or above in an average of 1.4 (SD 0.65) trials. The average BLS serious game score was 88.3/100 (SD 5.17) and hands-on average score was 70.7/100 (SD 17.3), whereas the OSCE average score was 84.4/100 (SD 12.9). There was no statistically significant correlation between success on trials (score ≥80/100), serious game, hands-on training app, and OSCE scores (Spearman rho test, P>.05). The mean BLS serious game score of the participants was 88.3/100 (SD 5.17), whereas their mean hands-on training app score was 70.7/100 (SD 17.3) and OSCE score was 84.4/100 (SD 12.9). Conclusions: Although scoring criteria for OSCE and hands-on training app were identical, OSCE scores were 17% higher than hands-on training app scores. After analyzing the difference of scores between hands-on training app and OSCE, it has been revealed that these differences originate from scoring parameters such as compression depth, compression frequency, and ventilation volume. These data suggest that evaluation of BLS trainings would be more objective if these evaluations were carried out with the modality, which combines visual OSCE scoring criteria with sensor data retrieved from the simulator’s sensors. Clinical Trial: ClinicalTrials.gov NCT04533893; https://clinicaltrials.gov/ct2/show/NCT04533893

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Background: Gamification and persuasive games are effective tools to motivate behavior change, particularly to promote daily physical activities. On the one hand, studies have suggested that a one-size-fits-all approach does not work well for persuasive game design. On the other hand, player modeling and recommender systems are increasingly used for personalizing content. However, there are few existing studies on how to build comprehensive player models for personalizing gamified systems, recommending daily physical activities, or the long-term effectiveness of such gamified exercise-promoting systems. Objective: This paper aims to introduce a gamified, 24/7 fitness assistant system that provides personalized recommendations and generates gamified content targeted at individual users to bridge the aforementioned gaps. This research aims to investigate how to design gamified physical activity interventions to achieve long-term engagement. Methods: We proposed a comprehensive model for gamified fitness recommender systems that uses detailed and dynamic player modeling and wearable-based tracking to provide personalized game features and activity recommendations. Data were collected from 40 participants (23 men and 17 women) who participated in a long-term investigation on the effectiveness of our recommender system that gradually establishes and updates an individual player model (for each unique user) over a period of 60 days. Results: Our results showed the feasibility and effectiveness of the proposed system, particularly for generating personalized exercise recommendations using player modeling. There was a statistically significant difference among the 3 groups (full, personalized, and gamified) for overall motivation (F3,36=22.49; P<.001), satisfaction (F3,36=22.12; P<.001), and preference (F3,36=15.0; P<.001), suggesting that both gamification and personalization have positive effects on the levels of motivation, satisfaction, and preference. Furthermore, qualitative results revealed that a customized storyline was the most requested feature, followed by a multiplayer mode, more quality recommendations, a feature for setting and tracking fitness goals, and more location-based features. Conclusions: On the basis of these results and drawing from the gamer modeling literature, we conclude that personalizing recommendations using player modeling and gamification can improve participants’ engagement and motivation toward fitness activities over time. Trial Registration:

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Health-related virtual reality (VR) applications for patient treatment, rehabilitation, and medical professional training are on the rise. However, there is little guidance on how to select and perform usability evaluations for VR health interventions compared to the supports that exist for other digital health technologies. The purpose of this viewpoint paper is to present an introductory summary of various usability testing approaches or methods that can be used for VR applications. Along with an overview of each, a list of resources is provided for readers to obtain additionally relevant information. Six categories of VR usability evaluations are described using a previously developed classification taxonomy specific to VR environments: (1) cognitive or task walkthrough, (2) graphical evaluation, (3) post hoc questionnaires or interviews, (4) physical performance evaluation, (5) user interface evaluation, and (6) heuristic evaluation. Given the growth of VR in health care, rigorous evaluation and usability testing is crucial in the development and implementation of novel VR interventions. The approaches outlined in this paper provide a starting point for conducting usability assessments for health-related VR applications; however, there is a need to also move beyond these to adopt those from the gaming industry, where assessments for both usability and user experience are routinely conducted.

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Background: Recently, ski exergames have been gaining popularity due to the growing interest in health improvement. Conventional studies evaluating the effects of ski exergames only considered exercise capacity and overlooked concentration. Ski exergames consist of a motion platform for exercise and virtual reality (VR) content in the game. The VR content enhances the exercise capacity and concentration of the user by providing a challenging goal. Objective: The aim of this study is to evaluate the effects of VR and non-VR exercises on the exercise capacity and concentration of users in a ski exergame. Methods: To examine the effects of the VR content in ski exergames, we performed 2 experiments, non-VR exercise and VR exercise, where participants exercised on the motion platform. If a user performs an exercise without using any VR content, it is a non-VR exercise. Contrastingly, in the case of VR exercise, a user exercises according to the VR content (a downhill scenario). In addition to the range of motion (ROM) of the ankle and rated perceived exertion (RPE) to assess exercise capacity, we used electroencephalography (EEG) to assess users’ concentration. Results: We evaluated the effects of the VR content by comparing the results obtained from VR and non-VR exercises. The ROM of the ankle with VR exercise was wider than that with non-VR exercise. Specifically, ROM of the ankle was 115.71° (SD 17.71°) and 78.50° (SD 20.43°) in VR exercise and non-VR exercise, respectively. The RPE difference between the 2 exercises was not statistically significant. The result of the sensorimotor rhythm waves (which are concentration-related EEG signals) was more favorable for VR exercise than non-VR exercise. The ratios of sensorimotor rhythm wave in EEG were 3.08% and 2.70% in the VR exercise and non-VR exercise, respectively. Conclusions: According to the results of this experiment, higher exercise capability and concentration were achieved with the VR exercise compared with non-VR exercise. The observations confirm that VR content can enhance both exercise capability and concentration of the user. Thus, the ski exergames can be used effectively by those who, in general, do not like exercise but enjoy games.

This is the abstract only. Read the full text free (open access) on the JMIR Serious Games website. JMIR is the leading ehealth publisher: fast peer-review - open access - high impact.