Background: Overall, 75% of health care practitioners are women, but half of all females do not play digital games of any kind. There is no consensus in the literature regarding optimal design elements to maximize the efficacy of serious games. To capitalize on the promise of serious games in health care education, it is important for instructional designers to understand the underlying learners’ values, attitudes, and beliefs that might motivate nongaming female health care preprofessional students to independently choose to persistently play serious games to mastery. Objective: Specifically, the aim of this study was to seek answers to 2 questions. First, what values, attitudes, and beliefs contribute to the nongaming behaviors of 12th-grade female emerging health care preprofessionals? Second, how do the values, attitudes, and beliefs of 12th-grade female emerging health care preprofessionals align with important design features of serious games? Methods: In this study, a learner analysis was conducted using semistructured interviews with 8 12th-grade college-bound female health science students to better understand learners’ values, attitudes, and beliefs to inform the design and development of a serious game. These interviewees represented a diverse subset of the female emerging health care preprofessionals who self-identified themselves as not playing games at all, not very often, or infrequently. Results: The findings suggest that the study participants exhibited a complex fusion of desire for both accomplishment and affiliation. The participants were all independent, competitive, and prosocial leaders. They thought strategically and consciously self-limited their leisure time to achieve personally meaningful long-term goals. They embraced overcoming expected failures and aimed to achieve relevant high-stakes wins in all academic, athletic, extracurricular, and leisure activities they valued while consciously avoiding what they considered to be non–goal-oriented activities. Conclusions: The results of this study reinforce the need for a robust learner analysis to identify the multifaceted behavioral characteristics of targeted learners before the design and development of serious games. The common characteristics of the 12th-grade female health science students in this study suggest that they will choose to invest their limited leisure time playing a personally meaningful, preprofessionally authentic serious game if the collective design elements are aligned with the students’ self-conceptualization of their present or future selves.

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.

Background: Virtual reality (VR) technology has been explored in the health sector as a novel tool for supporting treatment side effects, including managing pain and anxiety. VR has recently become more available with the launch of low-cost devices and apps. Objective: This study aimed to provide an updated review of the research into VR use for pain and anxiety in pediatric patients undergoing medical procedures. Specifically, we wanted to gain an understanding of the techniques and goals used in selecting or designing VR apps in this context. Methods: We performed a scoping review. To identify relevant studies, we searched three electronic databases. Two authors screened the titles and abstracts for relevance and eligibility criteria. Results: Overall, 1386 articles published between 2013 and 2018 were identified. In total 18 articles were included in the review, with 7 reporting significant reduction in pediatric pain or anxiety, 3 testing but finding no significant impact of the VR apps employed, and the rest not conducting any test of significance. We identified 9 articles that were based on VR apps specifically designed and tailored for pediatric patients. The findings were analyzed to develop a holistic model and describe the product, experience, and intervention aspects that need to be considered in designing such medical VR apps. Conclusions: VR has been demonstrated to be a viable choice for managing pain and anxiety in a range of medical treatments. However, commercial products lack diversity and meaningful design strategies are limited beyond distraction techniques. We propose future VR interventions to explore skill-building goals in apps characterized by dynamic feedback to the patient and experiential and product qualities that enable them to be an active participant in managing their own care. To achieve this, design must be part of the development.

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.

Background: Although teen pregnancy rates decreased dramatically in the United States over the past decade, the rates of sexually transmitted infections (STIs) among adolescents and young adults increased. STI rates disproportionately affect African American youth and young adults. Innovative, accessible, and culturally relevant sexual health interventions are urgently needed. Objective: This study aimed to identify the optimal modality for a game-based sexual health intervention; develop the educational, entertainment, and technological aspects of the serious game; and demonstrate its usability and acceptance by the target population. Methods: This project was grounded in formative data collection with community-based participatory research principles and practices combined with a user-centered design and development approach. Sexually Active Adolescent–Focused Education (SAAFE) was developed using input and feedback from African American youths aged 15 to 21 years who participated in a youth advisory board and focus group discussions to inform the co-design and cocreation of the serious game. The process was highly iterative with multiple sessions for user input following design changes. It proceeded in 3 stages. Social cognitive theory and problem-solving theory were leveraged to provide evidence-based, trauma-informed education through a serious game. Usability testing assessed the quality of user experience with the prototype. Results: Across all 3 stages, a total of 86 self-identified African American males and females aged 15 to 21 years from the District of Columbia and Birmingham, Alabama, participated. Participants requested a dating simulation game. They wanted SAAFE to be customizable, realistic, entertaining, educational, modern, and experiential, linking consequences to their gameplay decisions. Usability testing resulted in an initial System Usability Survey score of 77.7, placing the game in the 82nd percentile and above average for usability. Conclusions: Initial results suggest that the SAAFE prototype is a promising intervention to engage African American youth in sexual health education using a role-playing game. If proven efficacious, the game has the potential to meet the need for sex education, counterbalance unhealthy portrayals of sex in popular media, and respond to the disparities in the STI epidemic.

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.

Background: Anterior cruciate ligament reconstruction surgery is one of the most common orthopedic procedures. One of the main factors that influence the outcome is regaining strength in the postoperative phase. Because anterior cruciate ligament reconstruction surgeries are often performed in young patients, we combined the concept of prehabilitation with an app-based serious gaming approach to improve maximal strength postoperatively. Objective: Our objective was to conduct a prospective randomized trial to evaluate whether an app-based active muscle training program (GenuSport Knee Trainer) can improve postoperative strength by starting rehabilitation immediately after primary anterior cruciate ligament reconstruction surgery. Methods: We designed a pilot study in which we randomly assigned patients receiving primary anterior cruciate ligament reconstruction to either the serious gaming training (intervention) group or a conventional rehabilitation (control) group. Except for the serious gaming-based training, both groups followed the same postoperative treatment protocol. Outcome parameters were absolute and relative change in maximal strength, as well as the International Knee Documentation Committee Subjective Knee evaluation form, Knee Injury and Osteoarthritis Outcome Score, and Lysholm Knee Score. Results: In total 26 patients agreed to participate (14 patients in the intervention group and 12 patients in the control group, 1 of whom was lost to follow-up). We noted a difference in absolute maximum strength between the exergaming intervention and the control groups. Mean maximum strength preoperatively was 155.1 (SD 79.2) N in the intervention group (n=14) and 157.0 (SD 40.8) N in the control group (n=11). Postoperative mean maximum strength was 212.8 (SD 78.5) N in the intervention group and 154.5 (SD 27.1) N in the control group. Mean absolute change in maximum strength was 57.7 (SD 95.2) N in the intervention group and –4.8 (22.2) N in the control group. The analysis of covariance model with absolute change as the dependent variable and treatment group and baseline maximum strength as covariates showed a relevant difference in relative change between treatment groups (intervention – control) of 59.7 N (95% CI 10.1-109.3; P=.02). Similarly to the absolute increase, the relative change in maximum strength was relevantly higher in the exergaming group. The mean relative change in maximum strength was 1.7 (SD 1.17) in the intervention group and 1 (SD 0.13) in the control group. No adverse events or problems were reported during the study period. Conclusions: Implementation of an app-based active muscle training program in the early postoperative therapy scheme was associated with an improvement in maximal strength. Therefore, we considered the use of GenuSport training after anterior cruciate ligament reconstruction to be a helpful complement to rehabilitation after anterior cruciate ligament reconstruction surgery to improve strength in the early postoperative phase. To our knowledge this was the first study to analyze immediate postoperative serious gaming-based training with the GenuSport device based on strength improvement.

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.