Health Communication in Games at the Early Stage of COVID-19 Epidemic: A Grounded Theory Study Based on Plague, Inc

Objectives: An empirical study is carried out based on Plague, Inc. to explore whether the game has raised awareness of public health and urged players to make a better choice about health. Materials and Methods: Twenty-six college students from 24 cities in 11 provinces of China were investigated for a week-long survey. According to grounded theory principles, we coded original records from 69 diary reports using qualitative analysis tools. Results: We constructed nine core categories from participants' journals and drew the mechanism chart of the game as a means of health communication. The results showed that participants had experienced (1) an iterative learning process based on the authenticity and multiperspective features of the game and obtained specific learning outcomes; (2) deep thinking through the association between the game and the real world. And we extracted variables that are highly predictive of behavior change, including cognition of seriousness, cognition of susceptibility, action clue, and self-efficacy. Furthermore, noncore categories (including emotions and gameplay) directly and indirectly impacted players' learning and behavior change. Conclusion: The study shows Plague, Inc. has played a positive role in health communication (mainly reflected in the improvement of players' cognitive level, the establishment of health belief, and behavior changes). Moreover, it is concluded that reflection plays an important role in health communication interventions. However, careful consideration should be given to the use of this game as a means of health intervention due to its limitations and certain deficiencies.