JMIR Serious Games最新文献

Background: The gaming and gambling overlap has intensified with new evidence emerging. However, the relationship between gaming and gambling in the digital space is still inconclusive, especially in resource-limited Asian countries.

Objective: This study aims to review available evidence on the possible interaction and focuses specifically on the gateway interaction between gambling and gaming. Additionally, this review delves into the state of evidence from the Southeast Asian region, providing an in-depth analysis of this underexplored area.

Methods: We performed a scoping review by sifting through the publications in five databases. We focused on the gateway interaction and provided a possible pathway model, while two other convergence relationships were provided for comparison.

Results: The scoping review identified a total of 289 publications, with the majority being empirical (n=181), although only 12 studies used longitudinal designs. A significant proportion of the publications (n=152) concentrated on the correlation or comorbidity between gaming and gambling. Most of the evidence has originated from Global North countries, with very limited research emerging from Southeast Asia (n=8). The most commonly studied gambling-like element in video games was loot boxes (n=105). Other elements investigated included esports betting, skin betting, token wagering, gambling advertisements, and gambling-like features. Several longitudinal studies have highlighted the risk of the gateway effect associated with gamblification involvement. However, emerging evidence suggests more nuanced underlying mechanisms that drive the transition from gaming to gambling.

Conclusions: Overall, there is early evidence of linkage between gambling and gaming, through shared structural and biopsychosocial characteristics. This association possibly extends beyond disparate comorbidity, as such engagement in one activity might influence the risk of partaking in the other behavior. The field requires further longitudinal data to determine the directionality and significant precipitating factors of the gateway effect, particularly evidence from Asia.

Background: Children and adolescents are often at the crossroads of leisure gaming and excessive gaming. It is essential to identify the modifiable psychosocial factors influencing gaming disorder development. The lay theories of self-control (ie, the beliefs about whether self-control can be improved, also called self-control mindsets) may interplay with self-control and gaming disorder and serve as a promising influential factor for gaming disorder.

Objective: This study aims to answer the research questions "Does believing one's self-control is unchangeable predict more severe gaming disorder symptoms later?" and "Does the severity of gaming disorder symptoms prospectively predict self-control mindsets?" with a 1-year, 2-wave, school-based longitudinal survey.

Methods: A total of 3264 students (338 in grades 4-5 and 2926 in grades 7-10) from 15 schools in Hong Kong participated in the classroom surveys. We used cross-lagged panel models to examine the direction of the longitudinal association between self-control mindsets and gaming disorder.

Results: A bidirectional relationship was found between self-control mindsets and gaming disorder symptom severity (the cross-lagged path from mindsets to gaming disorder: regression coefficients [b] with 95% CI [0.070, 0.020-0.12o, P=.006]; and from gaming disorder to mindsets: b with 95% CI [0.11, 0.060-0.160, P<.001]). Subgroup analyses of boy and girl participants revealed that more growth mindsets regarding self-control predicted less severe gaming disorder symptoms in girls (b=0.12, 95% CI 0.053-0.190, P=.001) but not in boys (b=0.025, 95% CI -0.050 to 0.100, P=.51), while more severe gaming disorder symptoms predicted a more fixed mindset of self-control in both boys (b=0.15, 95% CI 0.069-0.230, P<.001) and girls (b=0.098, 95% CI 0.031-0.170, P=.004) after 1 year.

Conclusions: Our findings demonstrated the negative impact of gaming disorder on one's self-control malleability beliefs and implied that promoting a growth mindset regarding self-control might be a promising strategy for gaming disorder prevention and early intervention, especially for girls.

Background: Serious games play a fundamental role in promoting safe sexual behaviors. This medium has great potential for promoting healthy behaviors that prevent potential risk factors, such as sexually transmitted infections, and promote adherence to sexual health treatments, such as antiretroviral therapy. The ubiquity of mobile devices enhances access to such tools, increasing the effectiveness of video games as agents of change.

Objective: In this scoping review, we aimed to (1) identify the extent to which pervasive games have been used in the field of sexual health, (2) determine the theories used in the design and evaluation of pervasive games for sexual health, (3) identify the methods used to evaluate pervasive games for sexual health, and (4) explore the reported benefits of using pervasive games for sexual health.

Methods: Following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) methodology, we conducted a comprehensive literature search in the Web of Science, Scopus, IEEE Xplore, and ACM databases for articles published between January 1, 2000, and August 4, 2024. Included articles were published in English between 2000 and 2024 and involved the design, implementation, or evaluation of a ubiquitous video game focused on promoting safe sexual behaviors, with qualitative and/or quantitative results based on theory-based techniques and ubiquitous technologies. Review articles, conference papers, or books without available data or quantitative or qualitative results were excluded.

Results: We screened 521 of 612 articles (85.1%) after removing duplicates. After the title and abstract review, 51 (9.8%) articles were assessed for eligibility, and 30 (5.8%) articles meeting the criteria were studied and evaluated in depth. The results suggested that the use of pervasive video games has a positive impact on promoting safe sexual behaviors. This is enhanced by the effectiveness of theory-based techniques and the use of mobile technologies as developmental factors that drive the gaming experience. The results indicated that this domain is a growing field that should not be ignored.

Conclusions: The literature showed that pervasive video games have been effective in promoting safe sexual behaviors. Substantial growth has been seen in scientific community interest in researching this domain; nevertheless, there is still much to work on. In this context, we advocate for the standardization of design, implementation, and experimentation as essential phases in creating video game experiences. These 3 fundamental aspects are critical in the development of video game-based studies to ensure the reproducibility of experiments.

Background: Difficulties in emotional regulation are often observed in children and adolescents with attention-deficit/hyperactivity disorder (ADHD). Innovative complementary treatments, such as video games and virtual reality, have become increasingly appealing to patients. The Secret Trail of Moon (MOON) is a serious video game developed by a multidisciplinary team featuring cognitive training exercises. In this second randomized clinical trial, we evaluated the impact of a 20-session treatment with MOON on emotional regulation, as measured by the Strengths and Difficulties Questionnaire.

Objective: We hypothesize that patients with ADHD using MOON will show improvements in (1) emotional regulation, (2) core ADHD symptoms, (3) cognitive functioning, and (4) academic performance, compared to a control group; additionally, we anticipate that (5) changing the platform (from face-to-face using virtual reality to the web) will not affect emotional regulation scores; and (6) the video game will not cause any clinically significant side effects.

Methods: This was a prospective, unicentric, randomized, unblinded, pre- and postintervention study with block-randomized sequence masking. Participants included individuals aged between 7 and 18 years who had a clinical diagnosis of ADHD and were receiving pharmacological treatment. They were randomized into 2 groups using an electronic case report form: the MOON group, receiving standard pharmacological treatment plus personalized cognitive training via a serious video game, and the control group, receiving standard pharmacological treatment. We provided both the groups with psychoeducational support on ADHD. Analysis was conducted using the Student 2-tailed t test and 2-factor ANOVA. An independent monitor supervised the study.

Results: A total of 76 patients with ADHD participated in the trial, with an equal randomization (MOON: n=38, 50% and control: n=38, 50%) and a total dropout rate of 7. The primary hypothesis, a 3- or 4-point reduction in the global Strengths and Difficulties Questionnaire score, was not met. However, significant improvements were observed in material organization (P=.03), working memory (P=.04), and inhibition (P=.05), particularly among patients more engaged with the MOON treatment.

Conclusions: Serious video games, when integrated into a multimodal treatment plan, can enhance outcomes for symptoms associated with ADHD.

Trial registration: ClinicalTrials.gov NCT06006871; https://clinicaltrials.gov/study/NCT06006871.

International registered report identifier (irrid): RR2-10.2196/53191.

Background: This study evaluated the effectiveness of a virtual reality (VR) high-intensity interval training (HIIT) boxing protocol compared to traditional high-intensity circuit training (HICT) in improving exercise motivation, engagement, and physiological responses among 30 healthy medical students.

Objective: The purpose was to compare the VR HIIT protocol, which involved using an Oculus Quest 2 for a futuristic exoskeleton game experience, with a traditional 12-exercise HICT.

Methods: In total, 30 medical students engaged in both VR HIIT, using an Oculus Quest 2 for a futuristic exoskeleton game experience, and a traditional 12-exercise HICT. Metrics included heart rate (HR) and blood lactate levels before and after exercise alongside ratings of perceived exertion and the Situational Motivation Scale.

Results: VR HIIT showed significantly higher mean HR (mean 161, SD 15 vs mean 144, SD 11 bpm; d=1.5; P<.001), peak HR (mean 182, SD 15 vs mean 176, SD 11 bpm; d=0.8; P=.001), and ratings of perceived exertion (mean 16, SD 2 vs mean 15, SD 2; d=0.4; P=.03). Postexercise lactate levels were higher in HICT (mean 8.8, SD 4.5 vs mean 10.6, SD 3.0 mmol/L; d=0.6; P=.006). Intrinsic motivation and other psychological measures showed no significant differences, except for lower fatigue in HICT (d=0.5; P=.02).

Conclusions: VR HIIT significantly enhances physiological parameters while maintaining intrinsic motivation, making it a viable alternative to traditional HICT. However, the short-term nature of this study is a limitation, and future research should explore the long-term engagement and therapeutic impacts of VR exercise in diverse and clinical populations.

Background: Reminiscence therapy through music is a psychosocial intervention with benefits for older patients with neurocognitive disorders. Therapies using virtual or augmented reality are efficient in ecologically assessing, and eventually training, episodic memory in older populations. We designed a semi-immersive musical game called "A Life in Songs," which invites patients to immerse themselves in a past era through visuals and songs from that time period. The game aspires to become a playful, easy-to-use, and complete tool for the assessment, rehabilitation, and prevention of neurocognitive decline associated with aging.

Objective: This study aimed to assess the user experience (UX) associated with the newly designed serious game.

Methods: After one or several sessions of the game guided by the therapist, patients of the geriatric wards were asked to answer questions selected from 2 widely known UX scales (AttrakDiff and meCUE [modular evaluation of the components of user experience]) with the therapist's help. The internal consistency of the UX dimensions was assessed through Cronbach α to verify the validity of the dimensions. The level of engagement of the patient throughout the experimental session was also assessed following an internally developed scale, which included 5 levels (interactive, constructive, active, passive, and disengaged behaviors). UX mean scores were computed and presented graphically. Verbal feedbacks were reported to support the quantitative results.

Results: Overall, 60 inpatients with a mean age of 84.2 (SD 5.5) years, the majority of whom were women (41/60, 68%), were included. Their score on the Mini-Mental State Examination (MMSE) ranged between 12 and 29. A majority of patients (27/56, 48%) had no major neurocognitive disorder (MNCD), 22/56 (39%) had mild MNCD, and 7/56 (13%) had moderate MNCD. The results revealed very positive UX with mean values beyond the neutral values for every UX dimension of both scales. The overall mean (SD) judgment was rated 3.92 (SD 0.87) (on a scale of -5 to 5). Internal consistency was acceptable to good for the emotional dimensions of the meCUE. Questionable to unacceptable consistency was found for the other UX dimensions. Participants were mostly active (23/60, 38%) and constructive (21/60, 35%).

Conclusions: These findings demonstrated a very good appreciation of the game by geriatric inpatients. Participants' and health care professionals' verbal comments strongly aligned with the quantitative results. The poor internal consistency in the UX dimensions reflected the high heterogeneity among the included patients. Further studies are needed to evaluate the potential benefits of clinical factors such as neurocognitive functions, mood, depression, or quality of life.

Background: With substantial resources allocated to develop virtual reality (VR)-based rehabilitation exercise programs for poststroke motor rehabilitation, it is important to understand how patients with stroke perceive these technology-driven approaches, as their perceptions can determine acceptance and adherence.

Objective: This study aimed to examine the perceptions of patients with stroke regarding an immersive VR-based exercise system developed to deliver shoulder, elbow, forearm, wrist, and reaching exercises.

Methods: A questionnaire was used to assess the perceptions of 21 inpatients who had experienced stroke (mean time from stroke onset: 37.2, SD 25.9 days; Brunnstrom stage of stroke recovery for the arm: 3-5) regarding the perceived usefulness of, ease of use of, attitude toward, intrinsic motivation for, and intention to use the exercise system. The measurement items were rated on a 7-point Likert scale ranging from 1 (very strongly disagree) to 7 (very strongly agree), with higher values indicating more positive perceptions. Descriptive statistics were used to summarize the responses. Moreover, we conducted semistructured interviews that were audio recorded, transcribed, and subjected to content analysis to identify thematic patterns.

Results: The questionnaire results revealed that the patients' perceptions of the exercise system were positive (mean ratings >6). The content analysis revealed 6 positive themes from 73 statements about the exercise system: ease of use, usefulness, enjoyment, motivation, accessibility, and game design. Conversely, 15 statements reflected negative perceptions, which were clustered into 3 themes: difficulty in handling VR devices, uncomfortable experiences when using VR devices, and monotony.

Conclusions: Integrating VR technology into poststroke functional exercises holds significant promise based on patient interests. However, patient preferences and adaptability must be considered to promote the technology's success. VR-guided exercises should be user-friendly, health-promoting, engaging, and well-designed. Furthermore, addressing challenges, such as bulkiness, motion sickness, discomfort, and exercise monotony, is crucial for the widespread adoption and diffusion of this technology.

Background: For years, Mexico has reported the highest global incidence of school bullying, with approximately 19% of students going through some form of hostile peer interactions. Despite numerous interventions, these harmful conducts remain deeply entrenched in educational environments.

Objective: To address this issue, we developed Bernstein, a serious game that promotes assertiveness-an essential protective factor that reduces the negative effects of bullying.

Methods: Bernstein was designed using multiple composite scenarios, a methodology grounded in cognitive behavioral therapy. To evaluate the game's effectiveness, we conducted an exploratory trial using the Rathus Assertiveness Schedule to assess assertiveness levels before and after the intervention. Participants were high school students who met the inclusion criteria of being open to playing a serious game (with no prior gaming experience required) and having access to a computer with internet connectivity for remote participation. A total of 100 students (65 boys and 35 girls) enrolled in the intervention; however, only 46 participants in the treatment group and 46 in the control group completed the study, resulting in a dropout rate of 8% (8/100). A paired 1-tailed t test was used to compare pre- and postintervention scores within each group, and a one-way ANOVA was conducted to compare the average score improvements between the 2 groups.

Results: The treatment group showed a pretest mean Rathus Assertiveness Schedule score of -2.78 (SD 25.93) and a posttest mean of 1.69 (SD 29.48), with a paired 1-tailed t test yielding a P value of .01. The control group had a pretest mean of 2.07 (SD 25.69) and a posttest mean of -2.39 (SD 32.98), with a paired 1-tailed t test yielding a P value of .04. The one-way ANOVA (between groups) yielded a P value of .006, indicating a statistically significant difference, favoring Bernstein over the alternative protocol. Participant feedback highlighted the game's engaging narrative and character design, although usability issues, such as navigation challenges, were noted as areas for improvement.

Conclusions: The results suggest that Bernstein is a promising tool for promoting assertiveness in high school students, providing a potential strategy for addressing bullying-related issues. The study underscores the value of integrating Bernstein into educational programs, offering students a safe and interactive environment to develop resilience. As an exploratory trial, this study faced limitations affecting the generalizability of findings, including the remote format's impact on facilitator guidance and a relatively small sample size. Further trials with larger, more diverse groups are recommended to validate these early results and enhance Bernstein's scalability as part of a comprehensive antibullying strategy.