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Digital game technologies, that is, games and emerging game-based applications, are pervasively spread in society as a means of entertainment, education and exercise, amongst other uses. With this popularity, attention has been directed towards the accessibility of these technologies to people with disabilities to ensure equity, equal access to opportunities and realize earnings from a significant customer group. This study investigates: How is the attention of academic game accessibility research divided across game technologies, disability categories and use domains? And where is attention needed? To answer these questions, I conducted a review of research (162 manuscripts) on game technologies' accessibility published between 2016 and 2020, inclusive. The reviewed literature appears to have a utility focus (e.g. on education and health management) that relatively de-emphasizes the importance of game accessibility for entertainment or fun purposes. Auditory, motor and mobility disabilities, and emerging gamification, exergames, virtual reality (VR) and augmented reality (AR) are especially under researched in the academic domain. [ABSTRACT FROM AUTHOR]

In this article we present a web-based e-book used in educational context for teaching road safety to first grade students. The tool is a collection of situations that are presented in a game-based form. The players solve each situation in order to receive points. At the end of the course there is a final evaluation based on the training gaming situations. We use Unity game engine and WebGL for the development of the educational tool. In addition, the tool is cross-compiled for android mobile devices. We evaluate the learning effectiveness of the web-based tool via the t-test, analyze the results and draw conclusions. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study was to assess the current curricular status of content on infection prevention in hospitals during medical education prior to the development of a serious game on infection prevention in hospitals. In addition, the data collected was to be contrasted with the training for a specialist nurse in hygiene and infection prevention (FKHI). Methodology: In an online survey, persons in charge of medical degree programs and continuing education centers for FKHI, SkillsLabs and professional associations in Germany were asked to answer 28 questions on framework conditions, teaching, examinations, and gamification. Results: Data was collected for 22 medical degree programs and 5 FKHI continuing education centers. Due to the low response rate, the data for the FKHI was only analyzed in summary form. On average, 13.5 teaching units (median) are available in medical studies. Six degree programs have a longitudinal curriculum. In 7 of the 22 degree programs, teaching is based on the National Competency-Based Learning Objectives Catalogue (NKLM). Almost all locations teach this content in lectures (n=18) and/or in internships (n=13). Teaching and examinations are most common in the third year of study (n=12). In addition to practical OSCE examinations (n=5), written (n=12) and computer-based (n=8) examinations are used in particular. Gamification is known as a didactic approach to some extent but is not used for teaching infection prevention. Conclusions: Infection prevention in hospitals is given relatively low priority in medical education. Teaching and examinations are based on traditional knowledge-oriented formats, although practical teaching and practical examinations are established at some locations. In contrast to the FKHI, learning objectives currently appear to be less standardized. Further interprofessional development of teaching would be desirable in the future. [ABSTRACT FROM AUTHOR]

Serious games (i.e., digital games designed for educational purposes) can foster positive learning attitudes and are increasingly used as educational tools. Foodbot Factory is a serious game application (app) that helps children learn about healthy eating based on Canada's Food Guide principles and has demonstrated to increase nutrition knowledge among this group. This paper describes the process followed to expand Foodbot Factory's educational content and integrate immersive technologies and innovative features into the app. The revision process, which was guided by the Obesity-Related Behavioral Intervention Trials model, included the following phases: first, an interdisciplinary team of nutrition scientists, education experts, and computer scientists analyzed data from the original pilot study, recently published literature, and feedback from stakeholders to define areas to improve Foodbot Factory. The five original Foodbot Factory modules were evaluated by the team during weekly meetings, where the educational content, interactive features, and other elements that required updates (e.g., aesthetics and accessibility) were identified. Second, prototypes were created and refined until a final version of Foodbot Factory was approved. Nineteen children tested the updated Foodbot Factory and found it "easy to use" (89%) and "fun" (95%). The new version of Foodbot Factory contains 19 learning objectives, including 13 original and six new objectives. Interactive engagement features in the updated Foodbot Factory included augmented reality incorporated into two learning modules; new mini-games were created, including a memory game; an overhaul of the aesthetics; (e.g., new food images); and accessibility features were included to support users with cognitive and vision disabilities. [ABSTRACT FROM AUTHOR]

The use of game-related assessments (GRAs) in personnel selection is increasing. However, the type of GRA under investigation should be considered. This study focuses on game-based assessments, which closely resemble leisure-oriented videogames. We specifically examined a serious game that assesses personality traits (assertiveness, sociability, tolerance, and rules). We analyzed its predictive validity, applicant reactions, and the impact of personal and job-related factors on scores. The study included 182 participants who played the GRA and completed a Big Five questionnaire. Findings revealed that the game predicts adaptive performance, offering incremental value over the Big Five (ΔR2 =.107). Additionally, candidates reacted more positively to the GRA in terms of comfort and fit, although the effect size was small (d = -0.1757 and -0.3119, respectively). Relating to personal and job-related characteristics, only job experience significantly affected the assertiveness score, albeit with a small effect size (d = -0.3870). [ABSTRACT FROM AUTHOR]

Definition: Gamification, or gameful design, refers to the strategic application of game design principles, mechanics, and elements into non-game environments. It is often facilitated using digital platforms, aiming to solve problems, increase engagement, and motivate individuals towards their goals. The technique fosters a gameful and interactive experience, enhancing perceived autonomy, competence, and relatedness among users. With roots in fields like education, business, marketing, and services, gamification is a versatile tool that serves to enrich user experience and create value in a multitude of settings. The widespread impact of gamification across various sectors has transformed traditional methods of engagement, notably in education. [ABSTRACT FROM AUTHOR]

We propose a system for self-supported martial arts training using an IoT sensing platform and Serious Game that can also be extended for general sports training. In martial arts, it is important that the practitioner is correctly performing each technique to accurately learn and prevent injury. A common stance in all martial arts, but especially in Shaolin Kung Fu, is the horse stance or Mabu. With the pandemic, many more people adopted remote training without the presence of a professional trainer to give advice. Our developed LifeMat system, which is a novel IoT pressure-sensitive training mat, uses pressure maps and pattern recognition to accurately classify key martial arts postures, provide feedback on form, and detect when the user performs the technique incorrectly. This is presented in the form of a Serious Game we have developed named Kung Future that focuses on the Mabu stance as a case study. We tested 14 participants with three different feedback conditions and demonstrated that, on average, participants had higher performance, duration, engagement, and motivation when game feedback was active. Furthermore, user responses from the surveys suggested positive feedback for real-world and long-term use and scalability. [ABSTRACT FROM AUTHOR]

Managing passenger information during disruption (PIDD) is a significant factor in running effective and quick-to-recover rail operations. Disruptions are unpredictable, and their timely resolution is ultimately dependent on the expert knowledge of experienced frontline staff. The development of frontline employees by their employers usually takes the form of practice reviews and 'on-the-job' learning, while academic education majors on theoretical approaches and classroom-based teaching. This paper reports on a novel industry-funded project that has developed a serious game (the 'Rail Disruption Game') that combines theory and practice to better manage PIDD for frontline staff in a UK train operating company (TOC). It defines challenges and the development method for the Rail Disruption Game; it also incorporates developer and user feedback. This paper provides insight into how to design, make and deploy a serious game as part of a gamified management process. [ABSTRACT FROM AUTHOR]

The Cartesian coordinate system is a fundamental concept for mathematics and science and poses a teaching challenge at primary school level. Learning the Cartesian coordinate system has the potential to promote numerical cognition through number–space associations, as well as core geometric concepts, including isometric transformations, symmetry, and shape perception. Immersive virtual reality (VR) facilitates embodied forms of teaching and learning mathematics through whole-body sensorimotor interaction and offers benefits as a platform to learn the Cartesian coordinate system compared with "real world" classroom activities. Our goal was to validate the Cartesian-Garden, a serious game designed to provide an educationally robust but engaging vehicle to teach these concepts in primary-level mathematics in a multisensory VR environment. In the game, the child explores a Cartesian-Garden, that is, a field of flowers in which each flower corresponds to x and y coordinates. Specifically, we tested whether exploring numbers spatially represented improved spatial and numerical skills independently from the use of VR. Children (n = 49; age 7–11 years old) were divided into experimental and age-matched control groups. The experimental group explored the Cartesian-Garden and picked flowers corresponding to target coordinates; the control group played a VR game unrelated to Cartesian coordinates. To quantify potential improvements, children were tested before and after training with perceptual tests investigating number line and spatial thinking. The results point toward differential age-related improvements depending on the tested concept, especially for the number line. This study provides the guidelines for the successful use of the Cartesian-Garden game, beneficial for specific age groups. [ABSTRACT FROM AUTHOR]

In this study, we use two sensors – Kinect v 2.0 and Tobii 5.0 in order to detect and measure the attention levels of primary school students during the road safety educational classes. We use custom-developed road safety serious games for conducting the experiments with students in primary schools. One of the evaluation tools is a web-based e-book – a digital representation of a traditional textbook. The other tool is a 3D virtual platform for safety on the road. Both tools are developed using Unity 3D. Finally, we compare the selected road safety educational tools, discuss their strengths and weaknesses and draw conclusions. [ABSTRACT FROM AUTHOR]

Purpose: Escape room-based learning is a new educational game-based learning trend which embeds student learning within an exciting escape room scenario. Ordinarily these educational escape rooms are in a table-top format which involves learners decoding clues together around a table. In the age of a global pandemic [coronavirus disease 2019 (COVID-19)] with stringent social distancing and lock-downs, this normal game modality was not possible and so an alternate online approach was required. Thus, this paper aims to study escape room activities during global pandemics. Design/methodology/approach: In this paper, the authors outline how these escape room activities have been taken online, in an synchronous virtual environment and evaluate the student perception of these escape rooms, in contrast to previous cohorts of students who completed escape rooms together in person. Findings: The authors' results indicate that although students enjoy the escape room game-based learning environment, the remote nature of the activity means the students take longer to solve the puzzles. The students are also more likely to struggle in the activity and find them less engaging than the in-person escape room challenges. Originality/value: Although educational escape rooms have been devised for a variety of subjects and can be run through several different modalities (table-top, full rooms and online), this study compares different modalities (online vs table-top) for identical puzzles taken over different cohorts of students. [ABSTRACT FROM AUTHOR]

Despite the growing success of gamification in higher education, it is surprising there are still no studies focusing on its implementation in the field of public policy. This paper aims to fill this gap. This article reviews the origins, benefits, and limits of gamification. It also introduces a series of activities implemented previously: the use of Lego bricks, a Kahoot contest, a urban rally, a surviving game among urban gardens, an escape game, a SimCity competition, and a simulation based on Diplomacy. This paper must be considered as roadmap that should be adapted by teachers to their own context. We advocate for a moderate and reasonable use of gamification. This trend must be considered as a simple tool to facilitate learning, and not as an end in itself. [ABSTRACT FROM AUTHOR]

In search of a way to bring back the positive aspects of an internship into the curriculum, TU Delft identified serious games as a potential solution. The literature studied showed that games could increase motivation and understanding, leading to improve knowledge retention. This paper has brought these insights together in a framework identifying the benefits that contribute to knowledge retention but also the requirements and risks for the application of serious games to be addressed. These insights were used to explain the success of a longstanding business game course for advanced students first. Next was the development of a virtual reality practice in a first-year course to replace the lost internship. In this case, knowledge retention was improved significantly, albeit only by 5%. Furthermore, in light of the developed framework, the VR simulation is a more balanced approach with fewer risks compared to the more extensive master course. [ABSTRACT FROM AUTHOR]

Entertainment games have traditionally been articulated as leisure. However, they have also been used in the work context, in the form of serious games or gamification. In this qualitative research, we aimed to investigate the purpose of games used in the work context. To accomplish this, we conducted six semi-structured interviews and analyzed the discourses of the heads of the companies that produce serious games or gamification projects for work environments. Based on these statements, we assessed the views of the work context, the workers, and the projects the companies produce. We found that games have acquired different purposes, such as employee control to increase organizational results or enhance workers' happiness and wellbeing. Although these purposes seemed to stand out in all the analyzed speeches, several other different purposes emerged, according to the conditions of entry into the market and the type of projects produced. [ABSTRACT FROM AUTHOR]

Aim. The study aims to explore the current state of digital game-based learning to reflect the extent, possibilities, opportunities, and limitations of its implementation in the specific field of education as visual art, especially photography. Method. The explorative study employed the method of theoretical analysis of available literature and other secondary sources related to the issue, and subsequently applied the method of an illustrative (descriptive) case study. Results. Photo modes of commercially available digital games, originally intended to increase the players' retention and participation, have led to the birth of a new art form, virtual photography. The technology of photo modes in a larger variety of recent games has made virtual photography available to significantly more players. Photo modes provide artistic control and creative options alongside a whole catalogue of lenses, camera parameters, and other features, reducing the financial burden associated with the purchase of photographic equipment. Furthermore, photo modes offer more than just a substitutable alternative to traditional photography, as added artistic value is found within virtual worlds. Conclusions. Despite some limitations regarding the overall implementation of digital game-based learning in photography classrooms, photo modes of commercially available digital games are a suitable tool for educational efforts in photography through both self-development and measurement of outcome-based learning. [ABSTRACT FROM AUTHOR]

Background: A widely applied and effective rehabilitation method for patients experiencing spatial neglect after a stroke is "visual exploration training." Patients improve their ipsilesional bias of attention and orientation by training exploration movements and search strategies toward the contralesional side of space. In this context, gamification can have a positive influence on motivation for treatment and thus on the success of treatment. In contrast to virtual reality applications, treatment enhancements through augmented reality (AR) have not yet been investigated, although they offer some advantages over virtual reality. Objective: This study aimed to develop an AR-based app (Negami) for the treatment of spatial neglect that combines visual exploration training with active, contralesionally oriented rotation of the eyes, head, and trunk. Methods: The app inserts a virtual element (origami bird) into the real space surrounding the patient, which the patient explores with the camera of a tablet. Subjective reports from healthy elderly participants (n=10) and patients with spatial neglect after stroke (n=10) who trained with the new Negami app were analyzed. Usability, side effects, and game experience were assessed by various questionnaires. Results: Training at the highest defined difficulty level was perceived as differently challenging but not as frustrating by the group of healthy elderly participants. The app was rated with high usability, hardly any side effects, high motivation, and entertainment. The group of patients with spatial neglect after stroke consistently evaluated the app positively on the dimensions of motivation, satisfaction, and fun. Conclusions: The Negami app represents a promising extension by adding AR to traditional exploration training for spatial neglect. Through participants' natural interaction with the physical surrounding environment during playful tasks, side effects as symptoms of cybersickness are minimized and patients' motivation appeared to markedly increase. The use of AR in cognitive rehabilitation programs and the treatment of spatial neglect seems promising and should receive further investigation. [ABSTRACT FROM AUTHOR]

Gamification has been at the centre of research interest in different fields. It has been widely used in pedagogy, medical sciences, and business studies. A key methodology of gamification is serious games. Although these games are available for higher education institutions, they are costly, and the content of the game cannot be customised for specific classrooms. The aim of this study is to test a newly developed serious game that is freely accessible online and whose content can be customised. Measuring student satisfaction and experience, testing the game, and collecting feedback from students provide an opportunity to gain insight into whether students are satisfied with the newly developed serious game. More than 800 students participated in the online survey. Results were analysed using IBM SPSS. They show that students expect traditional educational material and tend to be less confident when facing entertaining material instead. [ABSTRACT FROM AUTHOR]

Eye-tracking technologies (ETs) and serious games (SGs) have emerged as new methods promising better support for vision screening and training. Previous research has shown the practicality of eye-tracking technology for vision screening in health care, but there remains a need for studies showing that the effective utilization of SGs and ETs are beneficial for vision training. This study investigates the feasibility of SGs and ETs for vision training by designing, developing, and evaluating a prototype influenced by commercially available games, based on a battery of exercises previously defined by vision experts. Data were collected from five participants, including a vision teacher, through a user experience questionnaire (UEQ) following a mixed method. Data analysis of the UEQ results and interviews highlighted the current challenges and positive attitudes in using SGs and ET for vision training. In conjunction with UEQ indicators such as attractiveness and perspicuity, the stimulation of the vision training battery based on the user experience provided insights into using ETs and further developing SGs to better approach different eye movements for vision training. [ABSTRACT FROM AUTHOR]

Contribution: This article compares the effectiveness for online software engineering education of video-based learning and game-based learning using teacher-authored educational video games created by using authoring tools. Background: Although substantial research has evaluated the impact of video-based and game-based learning versus traditional teaching approaches, little research has been done comparing the effectiveness of video-based learning and video game-based learning. Furthermore, the few studies that performed this comparison did not compare the effectiveness for online education or examined teacher-authored video games. Research Questions: Is game-based learning using teacher-authored video games more effective than video-based learning in terms of knowledge acquisition for software engineering students in online settings? Is game-based learning using teacher-authored video games more effective than video-based learning in terms of motivation for software engineering students in online settings? Methodology: A quasi-experimental design with control and experimental groups and pre- and post-tests was employed. A total of 180 software engineering students participated in this study, 81 of which belonged to the control group while the other 99 were part of the experimental group. The students in the control group took an online lesson in which they learned exclusively by watching videos, whereas the students in the experimental group took the same lesson but learned exclusively by playing an educational video game created by a teacher through an authoring tool. Findings: The results show that game-based learning using teacher-authored educational video games was more effective than video-based learning in terms of both knowledge acquisition and motivation. [ABSTRACT FROM AUTHOR]

Background: To overcome the high failure rate of gameful interventions, we need to better understand their design and evaluation strategies to build an evidence-base for best-practice approaches that bring about meaningful change. This systematic review asks: 'What behavioural and technological design and evaluation theories and approaches are applied in games developed to bring about positive environmental outcomes?'. Method: We reviewed 52 papers published between 2015 and 2020 that used gameful interventions to improve behaviour related to environmental outcomes. These papers were analysed to review the behavioural and technical design, and the assessment and evaluation approaches, employed by the intervention designers. Results: We found that these publications report on simple aspects of the behavioural and technical design behind the intervention but fail to justify their design choices in terms of theory and evidence. Furthermore, variability across their evaluation approaches and outcomes exists. Discussion: This review highlights several systemic flaws in the literature that limit our understanding of gameful interventions in the pro-environmental context. First, based on this review, we cannot be convinced that these interventions were designed according to best practice for intervention design or for technology development. Second, the justification for proposing a gameful intervention is not always clear. Finally, it is unclear whether these interventions are being evaluated based on best practice. Thus, it is not clear that we can draw confident conclusions about evidence-based outcomes of short-term engagement (in structural gamification interventions) or long-term behaviour change (in content gamification and serious game interventions). [ABSTRACT FROM AUTHOR]

Background: The stigma faced by people living with HIV causes difficulties in the treatment of HIV/AIDS. Decreasing this stigma is thus no less urgent than implementing behavioral interventions. Serious games are being increasingly adopted as an intervention mechanism to control HIV/AIDS around the world. However, the development and evaluation of these games in China are far from adequate. Objective: This research aimed to help decrease HIV-related stigma in China via the development and evaluation of a serious game, as well as promote a participatory gamification culture for health interventions. Methods: Initially, a serious game was developed using free resources from a user-generated content website. Then, quantitative and qualitative methods were employed for game evaluation. A randomized controlled trial was conducted to explore the game's effect on HIV-related stigma. The trial included 167 university students, who were randomly allocated to game and control groups. After the experimental evaluation, focus group discussions were held with 64 participants, who were invited to form 16 groups. Results: The game was called The Second Kind of Life with HIV (SKLWH), which is a free online game that can be played on computers and smartphones. This game hopes to publicize that people living with HIV can live a normal life, that is, a second life different from that imagined by the public. Based on the gamification practice of SKLWH, the participatory serious game development model (PSGDM) was proposed, which guided the development of 3 other HIV-themed games. The trial showed that intimacy stigma was much more severe than morality stigma and personal interaction stigma. Females were more tolerant of morality stigma than males (mean score: 1.29 vs 1.50; P=.01). The game intervention showed an advantage in decreasing intimacy stigma (mean score [game vs control]: 2.43 vs 2.73; P=.04). The group discussions validated the quantitative results and provided further in-depth information. The game intervention was largely preferred by participants, and the belief in intimacy impossibility was commonly expressed by participants when considering their relationship with people living with HIV. Conclusions: HIV/AIDS education should adopt appropriate media interventions to mitigate different dimensions of HIV-related stigma. Serious games should be used to decrease intimacy stigma, which is the hardest form to diminish. It is expected that the PSGDM can promote the development of more health games. Furthermore, HIV/AIDS intervention requires interdisciplinary efforts and cooperation that will allow more people to participate and share the responsibility of promoting health. [ABSTRACT FROM AUTHOR]

Grabbing and holding student attention was a big challenge even before the Covid- 19 era; however, the coronavirus and the obligatory digital education showed that new methods are needed to resolve these issues. One of them could be implementation of digital serious games. This paper presents the findings of a questionnaire about the feelings of students toward digital serious games. In all, 1755 answers were collected and analyzed and the results showed that most students do not shy away from using these kinds of video games in a classroom environment, although there are various concerns and key aspects educational professionals must consider. [ABSTRACT FROM AUTHOR]

Objectives: Our program implemented East EMWars, a year-long, longitudinal game that added competition to our existing curricular content. We surveyed residents to investigate the impact of gamification in emergency medicine residency training. We hypothesized that residents would report higher levels of motivation, engagement, and challenge with gamification compared to traditional didactics. Furthermore, we hypothesized that residents would exhibit generally positive perceptions about gamification as a learning tool and that it would translate to improved performance on the annual in-training examination. Methods: This was a single-center, prospective pre- and post-intervention survey study at a community-based emergency medicine residency program. Given the multiplicity of research questions and inherent nature of educational research, a mixed methods approach was utilized. We utilized nonparametric testing for quantitative data with paired responses pre- and post-intervention. We solicited comments on the post-intervention that were categorized under thematic approach and presented in complete and unedited form in the results. Results: Eighteen (100%) of eligible residents in our program participated in both surveys. There were statistically significant increases in reported levels of motivation, engagement, and challenge with gamification compared to traditional didactic methods. Residents also reported overwhelmingly positive general perceptions about gamification and its broader generalizability and applicability. We did not reach statistical significance in determining if in-training exam scores were associated with our gamification initiative. Conclusions: This study was a first-of-its-kind look into a longitudinal game in an emergency medicine residency program. Although our results are encouraging, medical educators need further research to determine if this increase in motivation, engagement, and challenge will be associated with an increase in examination scores or, more importantly, healthcare outcomes. Theory-based, broader-scale, prospective studies are needed to further explore and help establish these associations and outcomes. [ABSTRACT FROM AUTHOR]

Development of effective tools for cultural-heritage education is becoming more and more important in the times we live in. Interactive user activities and visual elements are necessary for better understanding of and immersion in the cultural heritage world. Objectives of our research include the applicability and criteria covered by tools for presenting cultural heritage content. The study is based on an empirical approach, divided in three stages. In the first phase we chose the instruments to be evaluated. The second phase identifies the criteria for evaluating these tools. In the third phase we perform an analysis of how these criteria are met and finally present the results. Our analysis showed that the reviewed instruments do not support all of the necessary specific functionalities and requirements. We think it is necessary to raise awareness among the respective scientific communities and developers of such tools that being able to access and use them smoothly is important for preserving our cultural heritage and educating children in this subject. [ABSTRACT FROM AUTHOR]

Student permanence rates decrease, and control is one of the greatest concerns of Higher Education Institutions for the fulfillment of their missionary processes. To mitigate the problem, different alternatives, methods, and methodologies have been proposed that support students without making a significant change in their perception of learning, therefore, making use of new technological trends and videogames interest, a strategy has been implemented that combines the courses teaching themes in a fun way as is the case of serious games. In accordance with the above, the purpose of this research is to carry out a systematic literature review (SLR) of those relevant studies that have considered the use of serious games in the reduction of dropout, to carry out their respective analysis and finally, to generate some conclusions regarding this topic. [ABSTRACT FROM AUTHOR]

Companies build strong employer brands to attract, motivate, and retain employees in crises, as it necessitates engagement and building relations with recruits. This study explores the application of gamification to employer branding and recruitment by analyzing organizational objectives for gamification. Game objectives were gamification-, recruitment-, and employer branding-related. We adopted a text analytics methodology and collected data—users' reviews (from Glassdoor and Google PlayStore) about the games they played during recruitment. The reviews showed positive and negative sentiments. We apply GAMEFULQUEST, including three components—immersion-related, achievement-related, and social-related—based on self-determination theory and related them to employer brand equity and employer brand engagement. [ABSTRACT FROM AUTHOR]

Background: Older adult women are at risk for negative health outcomes that engaging in sustained physical activity can help prevent. However, promoting long-term maintenance of physical activity in this population has proven to be a challenge. Increasing autonomous motivations (ie, intrinsic, integrated, and identified regulations) for physical activity may facilitate enduring behavior change. Digitally delivered games for health that take a celebratory technology approach, that is, using technology to create new ways to experience valued behaviors and express valued beliefs, may be a useful way to target autonomous motivations for physical activity. Formative research with the target population is needed to design compelling intervention content. Objective: The objective of this study is to investigate older adult women’s reactions to and thoughts about a photography-based, social media walking game targeting autonomous motivations for physical activity. Methods: During an individual semistructured interview, a moderator solicited feedback from 20 older adult women (age range 65-74 years) as part of formative research to develop a social media game featuring weekly walking challenges. The challenges were designed to target autonomous motivations for physical activity. Interviews were audio-recorded and transcribed verbatim. Two reviewers conducted thematic content analysis on interview transcripts. Results: We identified 3 overarching themes in qualitative data analysis. These reflected the playful experiences, value, and acceptability associated with the intervention challenges. Generally, participants understood what the challenges were asking them to do, proffered appropriate example responses, and indicated that the challenges would be enjoyable. Participants reported that the intervention content afforded many and varied playful experiences (eg, competition, discovery, exploration, expression, fellowship, humor, nurture, sensation). Further, participants indicated that the intervention increased their motivation for physical activity, occasioned meaningful shifts in perspective, increased their knowledge of various topics of interest, provided an opportunity to create valued connection with others, and provided health-related benefits. Participants suggested the intervention emphasize local history, nature, and cultural events. Conclusions: The photography-based, social media walking game with relatively simple game mechanics was well received and judged to be apt to bring about a wide variety of emotive experiences. A clear, geographically specific identity emerged as a key driver of interest for intervention content. Taking a celebratory technology approach holds promise for targeting autonomous motivations for physical activity in older adult women. [ABSTRACT FROM AUTHOR]

Background: Graduate education in modern diplomacy poses several challenges, as it requires several competencies to be developed before diplomatic service is joined. Incorporation of simulation games can have a positive impact on the design of international relations and diplomacy learning process. We have designed a novel role play game (MAEDRI) to simulate part of the activities of a typical Ministry of Foreign Affairs. Objective: This study aims to evaluate the effectiveness of MAEDRI in transferring knowledge in international relations education programs at the National University of Political Studies and Public Administration, Bucharest, Romania, across a 4-year period. Methods: The game enrolled master’s level graduate students. The data were collected through a voluntary and anonymous questionnaire between 2017 and 2020. At the end of each of the 4 editions we organized debriefing sessions that gave students the opportunity to provide feedback on their experience with this exercise, level of collaboration within the team, lessons learned, and to make suggestions for improvements. Using an online questionnaire, we measured the participants’ perception regarding the level of effectiveness in increasing knowledge transfer, motivation, and engagement. Questionnaire data were consolidated in percentages for each item. Results: A total of 49 participants completed the study. A total of 24 skills (13 professional and 11 social skills) were assessed. We identified a strong positive correlation between stress management and conflict management (r=.86; P<.001) as well as significantly positive correlations between building relations within the team and the ability to dialog and be persuasive (r=.7; P<.001), between procedure compliance and planning and organizing the work (r=.69; P<.001), and between analysis capacity and decision based on data received (r=.68; P<.001). Among social skills, self-control, confidence, and flexibility were the most substantially improved. Conclusions: We describe several benefits of a novel game, used as an education tool to enhance a series of competencies necessary in international relations studies. Our results demonstrate a significant level of student engagement and motivation while playing MAEDRI, improvement of several essential skills, and enhanced knowledge transfer to real-life situations. While the data are encouraging, further research is needed to evaluate the full impact of role play as an effective experiential learning method. [ABSTRACT FROM AUTHOR]

Background: Game-based learning appears to be a promising instructional method because of its engaging properties and positive effects on motivation and learning. There are numerous options to design game-based learning; however, there is little data-informed knowledge to guide the choice of the most effective game-based learning design for a given educational context. The effectiveness of game-based learning appears to be dependent on the degree to which players like the game. Hence, individual differences in game preferences should be taken into account when selecting a specific game-based learning design. Objective: We aimed to identify patterns in students’ perceptions of play and games—player types and their most important characteristics. Methods: We used Q methodology to identify patterns in opinions on game preferences. We recruited undergraduate medical and dental students to participate in our study and asked participants to sort and rank 49 statements on game preferences. These statements were derived from a prior focus group study and literature on game preferences. We used by-person factor analysis and varimax rotation to identify common viewpoints. Both factors and participants’ comments were used to interpret and describe patterns in game preferences. Results: From participants’ (n=102) responses, we identified 5 distinct patterns in game preferences: the social achiever, the explorer, the socializer, the competitor, and the troll. These patterns revolved around 2 salient themes: sociability and achievement. The 5 patterns differed regarding cheating, playing alone, story-telling, and the complexity of winning. Conclusions: The patterns were clearly interpretable, distinct, and showed that medical and dental students ranged widely in how they perceive play. Such patterns may suggest that it is important to take students’ game preferences into account when designing game-based learning and demonstrate that not every game-based learning-strategy fits all students. To the best of our knowledge, this study is the first to use a scientifically sound approach to identify player types. This can help future researchers and educators select effective game-based learning game elements purposefully and in a student-centered way. [ABSTRACT FROM AUTHOR]

Serious games aim to provide cognitive assessments that are more enjoyable and easier to self-administer, potentially leading to more frequent assessments. We carried out two studies examining the relationship between game-playing enjoyment, game difficulty, and cognitive (game) performance. In the first study, 16 participants played three serious games once a week over four weeks as part of an undergraduate course, but with relatively minor motivation in terms of course credits. In the second study, 14 participants played serious games over six sessions in a period of three weeks. Participants included graduate students receiving credit for the course project (a major component of the grade) and friends and family that they recruited. Performance in the more difficult tasks tended to improve over time in the second study, but not in the first. Participants from the first study showed an overall negative sentiment toward the games. However, participants from the second study enjoyed the majority of games except for the more difficult games that required players to temporarily hold and memorize information. Participants got significantly better in the more difficult working memory games, even though these games were less popular than the simpler games. Our interpretation of the results is that enjoyability is important in encouraging people to keep playing cognitive assessment games as time progresses, and that enjoyability helps in maintaining performance in easy games. Higher motivation on the other hand played a significant role in facilitating learning effects in difficult games as well as in maintaining enjoyability. [ABSTRACT FROM AUTHOR]

This article deals with the application of serious games to cultural heritage. Through an overview of the growing importance of gamification in promoting cultural sites and museum collections, the research highlights the changing practices of cultural institutions, which are increasingly involved in producing serious games, considering them as strategic digital marketing tools to promote cultural heritage and tourism in addition to their traditional "learning by playing" function. The article explores a case study, namely Mi Rasna, a game on the Etruscan society realized in partnership with several Italian cultural institutions. [ABSTRACT FROM AUTHOR]

Introduction: The medical field has incorporated gamification elements into education platforms over the past decade. The standard definition for gamification that has been adopted by most research studies is the addition of game elements and game mechanics within a platform to enhance user engagement. In this review, seven established, consolidated components, as well as an additional new or novel component, will be evaluated: a point system/leaderboards, question banks or gradable content, social interaction with other participants, leaderboards, progress or levels, immediate feedback, badges/icons or a reward system, and the novel component, a story line. Methods: Two reviewers searched MEDLINE, Cochrane, PsycINFO, Web of Knowledge, and the Nursing Registry. This review compares the one identified otolaryngology study with current residency education gamification practices within the medical field. The authors searched "residency AND gamification", "residency AND video games", and "residency AND games". After applying exclusion criteria, the 13 remaining studies included a procedure, questions/scenarios, and at least three gamification elements. Results: Across the 13 studies, the average number of included gamification elements was higher than the minimum threshold of three (3.84). Ten of the studies incorporated leaderboards, feedback, and social interaction; eight incorporated a question bank; and four incorporated progress bars, rewards, and story lines. The otolaryngology study incorporated four of the gamification components: a point system, instant feedback/solution after a question was answered, player‐to‐player communication, and a leaderboard. Conclusion: Review of the current literature found that the medical field has limited research regarding the use of gamification in educational platforms. Despite many simulation studies and attempts at gamification, the medical community has not fully embraced gamification within residency education. In closing, the medical education community should establish a definition of "gamification" and survey residency programs to identify desired gamification elements. [ABSTRACT FROM AUTHOR]

Background Hospitalisation-associated disability due to reduced physical activity levels and prolonged bedrest episodes are highly prevalent in older adults. Objective To assess the effect of gamified interventions on functional capacity in hospitalised older adults. Methods A three-armed non-randomised controlled trial with two experimental intervention groups and a control group was conducted in a tertiary public hospital in Navarre, Spain. Participants were allocated to a simple gamification group (SGG) (n  = 21), a technology-based gamification group (TGG) (n  = 23) or a control group (CG) (n  = 26). The end points were changes in functional capacity, muscle strength, cognition, mood status and quality of life. Results Seventy patients (mean age 86.01 ± 4.27 years old) were included in the study; 29 (41.4%) were women. At discharge, compared to CG, a mean increase of 1.47 points (95%CI, 0.15–2.80 points) and 2.69 points (95%CI, 1.32–4.06 points) was observed (SGG and TGG, respectively) in the SPPB test; as well as an increase of 5.28 points (95%CI, 0.70–9.76 points) in the Barthel Index and 2.03 kg (95%CI, 0.33–3.72 kg) in handgrip strength in the TGG. Regression mediation analyses demonstrated that muscle strength changes (β = 1.30; 95%CI, 0.45–2.14; indirect effect 0.864; 95%CI, 0.09–1.90) significantly mediated the TGG effect on the SPPB score. Conclusions The TGG intervention programme may provide significant benefits in physical and muscle function over usual care and seems to reverse the functional decline frequently associated with acute hospitalisation in older adults. [ABSTRACT FROM AUTHOR]

Background: Anxiety is a mental disorder characterized by apprehension, tension, uneasiness, and other related behavioral disturbances. One of the nonpharmacological treatments used for reducing anxiety is serious games, which are games that have a purpose other than entertainment. The effectiveness of serious games in alleviating anxiety has been investigated by several systematic reviews; however, they were limited by design and methodological weaknesses. Objective: This study aims to assess the effectiveness of serious games in alleviating anxiety by summarizing the results of previous studies and providing an up-to-date review. Methods: We conducted a systematic review of randomized controlled trials (RCTs). The following seven databases were searched: MEDLINE, CINAHL, PsycINFO, ACM Digital Library, IEEE Xplore, Scopus, and Google Scholar. We also conducted backward and forward reference list checking for the included studies and relevant reviews. Two reviewers independently carried out the study selection, data extraction, risk of bias assessment, and quality of evidence appraisal. We used a narrative and statistical approach, as appropriate, to synthesize the results of the included studies. Results: Of the 935 citations retrieved, 33 studies were included in this review. Of these, 22 RCTs were eventually included in the meta-analysis. Very low--quality evidence from 9 RCTs and 5 RCTs showed no statistically significant effect of exergames (games entailing physical exercises) on anxiety levels when compared with conventional exercises (P=.70) and no intervention (P=.27), respectively. Although 6 RCTs demonstrated a statistically and clinically significant effect of computerized cognitive behavioral therapy games on anxiety levels when compared with no intervention (P=.01), the quality of the evidence reported was low. Similarly, low-quality evidence from 3 RCTs showed a statistically and clinically significant effect of biofeedback games on anxiety levels when compared with conventional video games (P=.03). Conclusions: This review shows that exergames can be as effective as conventional exercises in alleviating anxiety; computerized cognitive behavioral therapy games and exergames can be more effective than no intervention, and biofeedback games can be more effective than conventional video games. However, our findings remain inconclusive, mainly because there was a high risk of bias in the individual studies included, the quality of meta-analyzed evidence was low, few studies were included in some meta-analyses, patients without anxiety were recruited in most studies, and purpose-shifted serious games were used in most studies. Therefore, serious games should be considered complementary to existing interventions. Researchers should use serious games that are designed specifically to alleviate depression, deliver other therapeutic modalities, and recruit a diverse population of patients with anxiety. [ABSTRACT FROM AUTHOR]

Background: Complex movement pathologies that are biopsychosocial in nature (eg, back pain) require a multidimensional approach for effective treatment. Virtual reality is a promising tool for rehabilitation, where therapeutic interventions can be gamified to promote and train specific movement behaviors while increasing enjoyment, engagement, and retention. We have previously created virtual reality--based tools to assess and promote lumbar excursion during reaching and functional gameplay tasks by manipulating the position of static and dynamic contact targets. Based on the framework of graded exposure rehabilitation, we have created a new virtual reality therapy aimed to alter movement speed while retaining the movement-promoting features of our other developments. Objective: This study aims to compare lumbar flexion excursion and velocity across our previous and newly developed virtual reality tools in a healthy control cohort. Methods: A total of 31 healthy participants (16 males, 15 females) took part in 3 gamified virtual reality therapies (ie, Reachality, Fishality, and Dodgeality), while whole-body 3D kinematics were collected at 100 Hz using a 14-camera motion capture system. Lumbar excursion, lumbar flexion velocity, and actual target impact location in the anterior and vertical direction were compared across each virtual reality task and between the 4 anthropometrically defined intended target impact locations using separate 2-way repeated measures analysis of variance models. Results: There was an interaction between game and impact height for each outcome (all P<.001). Post-hoc simple effects models revealed that lumbar excursion was reduced during Reachality and Fishality relative to that during Dodgeality for the 2 higher impact heights but was greater during Reachality than during Fishality and Dodgeality for the lowest impact height. Peak lumbar flexion velocity was greater during Dodgeality than during Fishality and Reachality across heights. Actual target impact locations during Dodgeality and Fishality were lower relative to those during Reachality at higher intended impact locations but higher at lower intended impact locations. Finally, actual target impact location was further in the anterior direction for Reachality compared to that for Fishality and for Fishality relative to that for Dodgeality. Conclusions: Lumbar flexion velocity was reduced during Fishality relative to that during Dodgeality and resembled velocity demands more similar to those for a self-paced reaching task (ie, Reachality). Additionally, lumbar motion and target impact location during Fishality were more similar to those during Reachality than to those during Dodgeality, which suggests that this new virtual reality game is an effective tool for shaping movement. These findings are encouraging for future research aimed at developing an individualized and graded virtual reality intervention for patients with low back pain and a high fear of movement. [ABSTRACT FROM AUTHOR]

Aim/Purpose The key objective of this research is to examine whether fix-and-play educational games improve students' performance in learning programming languages. We also quantified the flow experiences of the students and analyzed how the flow contributes to their academic performances. Background Traditionally, learning the first computer programming language is considered challenging, In this study, we propose the fix-and-play gaming approach that utilizes the following three facts to alleviate certain difficulties associated with learning programming: 1. digital games are computer programs, 2. young students are fond of playing digital games, and 3. students are interested in creating their own games. Methodology A simple casual game Shoot2Learn was created for learning the fundamentals of branching. A number of errors were intentionally implanted in the game at different levels, and the students were challenged to fix the bugs before continuing the game. During the play, the program keeps records of the student’s academic progress and the time logs at different stages to measure the flow experience of the students. The proposed approach was systematically evaluated using a quasi-experimental design in real classroom settings in two countries, Sri Lanka, and USA. Contribution The results derived from this research provide empirical evidence that the fix-and-play educational games ease some challenges in learning programming and motivate the students to play and learn. Findings The results show that the first-year programming students who play the fix-and-play game gain statistically significant improvement in their academic performance. However, the result fails to suggest a significant positive correlation between the flow experience and academic performance. Recommendations for Practitioners Empowering the students to fix the bugs in the educational games they play will motivate them to stay in the game and learn continuously. However, we have to make sure that the types and timing of bugs do not hinder the flow experience of the players, Recommendation for Researchers Students normally play industry-level high-quality games. Experience and interest in game-playing differ significantly between students. Gender difference also plays an important role in selecting game genres. We need to identify how to address these issues when resources are not sufficient to provide an individualized gaming experience. Impact on Society Programming is an essential skill for computer science students. The outcome of this research shows that the proposed approach helps to reduce the disenchantment associated with learning the first programming language. Future Research Further investigation is necessary to verify whether the AI techniques such as user modeling can be used in educational games to reduce the effects of uncertainty associated with the variations in students' gaming skills and other factors. [ABSTRACT FROM AUTHOR]

Researchers struggle to apply insights from psychology to learning with video games as individual differences while playing them vastly differ. In addition, some elements are uncommon within learning material, such as having a pedagogical agent as an opponent. To meet this gap, this article presents a pre-study (n = 150) and experiments (n = 98; n = 85) investigating the type of opponent (high versus low emotionally activating) and the perceived game difficulty (high versus low). Results indicate significant effects on perceived competence and attribution. In addition, the impact of emotional activation interacted with the individual gameplay experiences. However, effects regarding emotional activation could not be fully replicated, indicating an influence of the game-based scenario. In addition, it could be demonstrated that learning was not impaired, even though individual player behavior and performance during the learning phase differed significantly. Results are discussed regarding the optimal design of individualized learning material. The experimental series revealed that even the perception of difficulty – not the difficulty of the material itself – results in individual differences in player behavior, perceived competence, and attribution. It could be demonstrated that such individual game experiences can influence learning-related actions, such as playing more slowly and carefully, attributing more internally, and feeling more competent without actual differences within the content of the learning material. The importance of resulting perceived competence is further highlighted, as it could be demonstrated that it is an essential mediator for the emergence of positive emotional responses (i.e., feeling happy) after playing an educational video game. Overall, the results indicate the strong potential of adaptive digital Game-Based Learning scenarios, adjusting the gameplay experience toward an individualized and optimized path. • Discovery of the effect of perceived difficulty on individual differences in player behavior, competence, and attribution. • Perceived competence was a mediator for the emergence of positive emotional responses after playing an educational game. • Results indicate the potential of adaptive DGBL, adjusting the play experience toward an individualized and optimized path. • Experiments add to the scarce literature by comparing manipulated game versions with appropriate counterparts. [ABSTRACT FROM AUTHOR]

Gamification is usually defined as the use of game structure components in circumstances that are not commonly associated with games. In engineering studies, Gamification and its sub-concept of Serious Games are rather widespread pedagogical models. Just like in other application scopes, the approach to their utilisation or analysis is always concerned with the players, their psychological experience and the relevance of their learning outcomes. The aim of this work is to illustrate the results of a different approach, the 'Learner-Designer Approach to Serious Games' (LDASG). The study was carried out through a single group variation on the two-group posttest-only randomised experiment and performed on 79 second year undergraduate students of an Industrial Plant Design course within a Management Engineering programme. Quantitative data on the students' learning performance and learning experience were collected through a test and a questionnaire, respectively. The test results were analyzed by means of the Paired Samples Test and effect sizes were calculated. As to the questionnaire, a descriptive analysis was employed. The outcomes obtained show how LDASG can successfully compete with other active learning methodologies. [ABSTRACT FROM AUTHOR]

In recent years there has been a renewal of educational software encouraged by the incorporation of specific designs based on serious games. Previous studies on their use do not provide conclusive data on the advancement in learning, both at a general level and in specific contents. The main objective of this work is to study the impact of the use of serious games in primary education classrooms, specifically on mathematics fluency, taking into account gamification variables and teaching experience. A quasi-experimental study was carried out with a pretest-posttest design, without a control group and with several experimental groups, involving 284 students from the first to the fourth grade. The results show a significant improvement in mathematics fluency with the use of serious games in the different grades and classroom groups studied. The gamification strategy promotes even greater progress over the classes where it has not been implemented. There is a similar time of use of serious games by both novice and experienced teachers, with better results in mathematics fluency in the case of the second group. It also shows the relationship between the results obtained and the school grades of the students. The findings point to the potential of using serious games designed specifically for school environments and challenge previous work on generational barriers in teachers. [ABSTRACT FROM AUTHOR]

Background: Games for health are a promising approach to health promotion. Their success depends on achieving both experiential (game) and instrumental (health) objectives. There is little to guide game for health (G4H) designers in integrating the science of behavior change with the art of game design. Objective: The aim of this study is to extend the Behaviour Change Wheel program planning model to develop Challenges for Healthy Aging: Leveraging Limits for Engaging Networked Game-Based Exercise (CHALLENGE), a G4H centered on increasing physical activity in insufficiently active older women. Methods: We present and apply the G4H Mechanics, Experiences, and Change (MECHA) process, which supplements the Behaviour Change Wheel program planning model. The additional steps are centered on identifying target G4H player experiences and corresponding game mechanics to help game designers integrate design elements and G4H objectives into behavioral interventions. Results: We identified a target behavior of increasing moderate-intensity walking among insufficiently active older women and key psychosocial determinants of this behavior from self-determination theory (eg, autonomy). We used MECHA to map these constructs to intervention functions (eg, persuasion) and G4H target player experiences (eg, captivation). Next, we identified behavior change techniques (eg, framing or reframing) and specific game mechanics (eg, transforming) to help realize intervention functions and elicit targeted player experiences. Conclusions: MECHA can help researchers map specific linkages between distal intervention objectives and more proximal game design mechanics in games for health. This can facilitate G4H program planning, evaluation, and clearer scientific communication. [ABSTRACT FROM AUTHOR]

Background: The misuse of opioid medications among adolescents is a serious problem in the United States. Serious games (SGs) are a novel way to promote the safe and responsible management of opioid medications among adolescents, thereby reducing the number of adolescent opioid misuse cases reported annually. Objective: This study aimed to examine the effect of the SG MedSMART: Adventures in PharmaCity on adolescents' opioid safety knowledge, awareness, behavioral intent, and self-efficacy. Methods: A nationally representative sample of adolescents aged 12 to 18 years were recruited online through Qualtrics panels from October to November 2020. Data collection consisted of a pregame survey, 30 minutes of gameplay, and a postgame survey. The pregame and postgame surveys included 66 items examining the participants' baseline opioid knowledge, safety, use, and demographic information. The postgame survey had 25 additional questions regarding the MedSMART game. Gameplay scenarios included 5 levels intended to mimic adolescents' daily life while educating the players about appropriate opioid storage and disposable practices, negative consequences of sharing opioid medications, and the use of Narcan. Survey questions were divided into 10 categories to represent key concepts and were summarized into concept scores. Differences in concept scores were described by overall mean (SD) when stratified by gender, race, school, grade, and age. Differences of change in concept score were analyzed using the Kruskal-Wallis and correlation tests. Results: A total of 117 responses were analyzed. The results showed significant improvement on all concept scores except for Narcan knowledge (mean change -0.04, SD 0.29; P=.60) and safe storage (mean change 0.03, SD 0.20; P=.09). Female participants had greater improvement than males for safe disposal (female mean 0.12, SD 0.25 vs male mean 0.04, SD 0.17; P=.05). Male participants had higher improvement than female participants for misuse behavior (female mean 0.05, SD 0.28 vs male mean 0.14, SD 0.27; P=.04). Perceived knowledge for participants who had non-White or Hispanic racial backgrounds had higher improvement than for non-Hispanic White participants (non-White mean 1.10, SD 1.06 vs White mean 0.75, SD 0.91; P=.03). Older grades were associated with greater improvement in opioid knowledge (correlation coefficient -0.23, 95% CI -0.40 to -0.05; P=.01). There were 28 (23.9%) participants who played all 5 levels of the game and had better improvement in opioid use self-efficacy. Conclusions: Our findings suggest MedSMART: Adventures in PharmaCity can be used as an effective tool to educate adolescents on the safe and responsible use of prescribed opioid medications. Future testing of the effectiveness of this SG should involve a randomized controlled trial. Additionally, the feasibility of implementing and disseminating MedSMART: Adventures in PharmaCity in schools and health care settings such as adolescent health or primary care clinics, emergency departments, and pharmacies should be investigated. [ABSTRACT FROM AUTHOR]

Serious games show a lot of potential for use in movement rehabilitation (eg, after a stroke, injury to the spinal cord, or limb loss). However, the nature of this research leads to diversity both in the background of the researchers and in the approaches of their investigation. Our close examination and categorization of virtual training software for upper limb prosthetic rehabilitation found that researchers typically followed one of two broad approaches: (1) focusing on the game design aspects to increase engagement and muscle training and (2) concentrating on an accurate representation of prosthetic training tasks, to induce task-specific skill transfer. Previous studies indicate muscle training alone does not lead to improved prosthetic control without a transfer-enabling task structure. However, the literature shows a recent surge in the number of game-based prosthetic training tools, which focus on engagement without heeding the importance of skill transfer. This influx appears to have been strongly influenced by the availability of both software and hardware, specifically the launch of a commercially available acquisition device and freely available high-profile game development engines. In this Viewpoint, we share our perspective on the current trends and progress of serious games for prosthetic training. [ABSTRACT FROM AUTHOR]

The behavioral aspect of cybersecurity has gained more attention in recent years. By their actions, people can improve the security of their devices and organizations, but also hinder the successful implementation of security in these areas. As awareness campaigns where information is merely distributed are not effective, we designed a cybersecurity serious game applicable for cybersecurity training. The effectiveness of this game was experimentally tested against a noncybersecurity game that did or did not contain cybersecurity information, through measures of the theory of planned behavior. Results showed that the cybersecurity game resulted in higher self-reported scores on attitudes, perceived behavioral control, intentions, and behavior compared with both noncybersecurity games. For subjective norms, we only found an effect in the comparison between the cybersecurity game and the noncybersecurity game without additional information. [ABSTRACT FROM AUTHOR]

This article describes the results of a qualitative study that aimed at investigating moral decision-making processes of prospective government workers using a game-based tool. Three participants volunteered to participate in the research process, which included playing a short point-and-click narrative game and a focus group. Data was analyzed through thematic analysis as well as narrative maps which emphasized players' decisions. Analysis indicated similarities among participants' moral decision-making processes, from initial experiment and struggles with the tool to the application of personal and professional experiences to the game scenario. Additionally, levels of empathic engagement were found to be conditioned upon participants' approaches to play. The results of this exploratory study shed light into aspects of moral decision-making with serious games and allow for the suggestion of instructional practices to raise learners' moral self-awareness through game-based learning. [ABSTRACT FROM AUTHOR]

Background: Serious games are now widely used in many contexts, including psychological research and clinical use. One area of growing interest is that of cognitive assessment, which seeks to measure different cognitive functions such as memory, attention, and perception. Measuring these functions at both the population and individual levels can inform research and indicate health issues. Attention is an important function to assess, as an accurate measure of attention can help diagnose many common disorders, such as attention-deficit/hyperactivity disorder and dementia. However, using games to assess attention poses unique problems, as games inherently manipulate attention through elements such as sound effects, graphics, and rewards, and research on adding game elements to assessments (ie, gamification) has shown mixed results. The process for developing cognitive tasks is robust, with high psychometric standards that must be met before these tasks are used for assessment. Although games offer more diverse approaches for assessment, there is no standard for how they should be developed or evaluated. Objective: To better understand the field and provide guidance to interdisciplinary researchers, we aim to answer the question: How are digital games used for the cognitive assessment of attention made and measured? Methods: We searched several databases for papers that described a digital game used to assess attention that could be deployed remotely without specialized hardware. We used Rayyan, a systematic review software, to screen the records before conducting a systematic review. Results: The initial database search returned 49,365 papers. Our screening process resulted in a total of 74 papers that used a digital game to measure cognitive functions related to attention. Across the studies in our review, we found three approaches to making assessment games: gamifying cognitive tasks, creating custom games based on theories of cognition, and exploring potential assessment properties of commercial games. With regard to measuring the assessment properties of these games (eg, how accurately they assess attention), we found three approaches: comparison to a traditional cognitive task, comparison to a clinical diagnosis, and comparison to knowledge of cognition; however, most studies in our review did not evaluate the game's properties (eg, if participants enjoyed the game). Conclusions: Our review provides an overview of how games used for the assessment of attention are developed and evaluated. We further identified three barriers to advancing the field: reliance on assumptions, lack of evaluation, and lack of integration and standardization. We then recommend the best practices to address these barriers. Our review can act as a resource to help guide the field toward more standardized approaches and rigorous evaluation required for the widespread adoption of assessment games. [ABSTRACT FROM AUTHOR]

Background: In times where distance learning is becoming the norm, game-based learning (GBL) is increasingly applied to health profession education. Yet, decisions for if, when, how, and for whom GBL should be designed cannot be made on a solid empirical basis. Though the act of play seems to be intertwined with GBL, it is generally ignored in the current scientific literature. Objective: The objective of our study was to explore students' perceptions of play in leisure time and of GBL as part of a mechanistic, bottom-up approach towards evidence-informed design and implementation of GBL in health profession education. Methods: We conducted 6 focus group discussions with medical and dentistry students, which were analyzed using thematic analysis. Results: A total of 58 students participated. We identified 4 major themes based on the students' perception of play in leisure time and on the combination of play and learning. Our results indicate that, while play preferences were highly various in our health profession student cohort, pleasure was the common ground reported for playing. Crucially, play and the serious act of learning seemed paradoxical, indicating that the value and meaning of play are strongly context-dependent for students. Conclusions: Four key points can be constructed from our study. First, students play for pleasure. Perceptions of pleasure vary considerably among students. Second, students consider play as inefficient. Inefficiency will only be justified when it increases learning. Third, play should be balanced with the serious and only be used for difficult or tedious courses. Fourth, GBL activities should not be made compulsory for students. We provide practical implications and directions for future research. [ABSTRACT FROM AUTHOR]

PURPOSE: To assess the changes in balance function in children with cerebral palsy (CP) after two weeks of daily training with personalized balance games. METHODS: Twenty-five children with CP, aged 5 to 18 years were randomly selected for experimental or control groups. Over a period of two weeks, all participants received 8–9 game sessions for 15–20 minutes, totaling 150–160 minutes. The experimental group used personalized balance games available from the GAmification for Better LifE (GABLE) online serious gaming platform. Children from the control group played Nintendo Wii games using a handheld Wii Remote. Both groups received the same background treatment. Recorded outcome measures were from a Trunk Control Measurement Scale (TCMS), Timed Up & Go Test (TUG), Center of Pressure Path Length (COP-PL), and Dynamic Balance Test (DBT). RESULTS: After two weeks of training in the experimental group TCMS scores increased by 4.5 points (SD = 3.5, p < 0.05) and DBT results increased by 0.88 points (IQR = 1.03, p < 0.05) while these scores did not change significantly in the control group. Overall, TUG and COP-PL scores were not affected in either group. CONCLUSION: This study demonstrates improvement of balancing function in children with CP after a two-week course of training with personalized rehabilitation computer games. [ABSTRACT FROM AUTHOR]

This paper responds to a 2016 systematic literature review of the research on learning games by Ke (Educ Technol Res Dev 64(2):219–244, 2016). The review paper unpacked the idea of intrinsic integration in learning games, analyzing important emergent themes. The key ideas and the value of this review are discussed in the context of the recent shift to virtual instruction. The limitations, impact, and future implications are also described, with the perspective of this response focused on education theory. Intrinsic integration is an important consideration when designers create the next generation of digital games, and as researchers try to untangle the affordances of different educational games for student learning. [ABSTRACT FROM AUTHOR]

Gamification has been widely used in non-gaming contexts to motivate participants to actively engage in tasks. However, game difficulty can alter the efficacy of different motivational elements (e.g., rewards, feedback, and leaderboards). To examine the relationship between game difficulty and participant motivation, we report findings from two studies (N > 400 for the two studies combined) on gamified assessments for cognitive executive functions. In each study, the same set of five different reward conditions are compared in a between-subjects design. The studies used cognitive tasks, implemented as modified Whack-A-Mole games, where students had to make a cognitively defined (e.g., working memory, or response inhibition) distinction between target (to be hit) and distractor (not to be hit) characters (moles). Response time and accuracy were collected along with rated game enjoyment and motivation. Overall, Leaderboard was the most enjoyable reward condition. The Within-subject Comparison condition provided self-comparison feedback and led to stable performance over time. A key result was that peer competition motivated better performance in easy, but not difficult tasks. • Four types of gamification rewards for cognitive task performance were designed. • Leaderboard was found to be the most enjoyable reward condition. • Self-comparison retained higher performance consistency. • Design guidelines were offered for the use of gamified rewards in cognitive tasks. • Rewards were less able to increase enjoyment in difficult (vs. easy) tasks. [ABSTRACT FROM AUTHOR]

Digital game technologies, that is, games and emerging game-based applications, are pervasively spread in society as a means of entertainment, education and exercise, amongst other uses. With this popularity, attention has been directed towards the accessibility of these technologies to people with disabilities to ensure equity, equal access to opportunities and realize earnings from a significant customer group. This study investigates: How is the attention of academic game accessibility research divided across game technologies, disability categories and use domains? And where is attention needed? To answer these questions, I conducted a review of research (162 manuscripts) on game technologies’ accessibility published between 2016 and 2020, inclusive. The reviewed literature appears to have a utility focus (e.g. on education and health management) that relatively de-emphasizes the importance of game accessibility for entertainment or fun purposes. Auditory, motor and mobility disabilities, and emerging gamification, exergames, virtual reality (VR) and augmented reality (AR) are especially under researched in the academic domain. [ABSTRACT FROM AUTHOR]