Presentation by Debra Lieberman at the 2012 Games for Health Conference

1. Current Research on Games for
Managing Chronic Conditions
Presentation to the Games for Health Conference
Boston, MA
Debra Lieberman, Erica Biely,
Ramsey Nijem, & Marta Delcor
UC Santa Barbara
June 13, 2012

2. We found games & research on these
chronic conditions
 Diabetes  Crohn’s disease
 Asthma  HIV / AIDS
 Kidney disease  Multiple sclerosis
 Malaria  Heart Disease
 Hepatitis  Cancer
 Tuberculosis  STDs, STIs
 Sickle cell disease  Autism
 Hypertension  Depression
 Arthritis  Alzheimer’s
 Cystic fibrosis

3. Some patterns / similarities emerged
 Can we boil most self-management games down to
just a few game designs?
 Likewise, is the research limited to a few repeating
study designs and research questions?
 So, I ask you to provide counter-examples:
 Where are examples of innovation?
 What are your ideas for innovation?
 Here are the patterns we found in today’s games:

4. 5 chronic condition game “genres” or formats
1. Knowledge games
2. Self-management skill games
3. Simulation games
4. Nurturing games
5. Goal setting and social support games
(not discussed today; used mostly for fitness and prevention,
but there is great potential for disease self-management)
Some games are hybrids of two or more genres

5. Characters
1. No characters (puzzles, card games)
2. Fantasy characters
3. Realistic characters
4. Self character (avatar)
5. Helper character / tutor / doctor / sage
6. Co-learner character that models the joy of discovery
7. Role model characters (positive, negative, transitional)
8. Enemies that cause illness
Some characters have the chronic condition, some do not

6. Settings
1. No setting (puzzles, card games)
2. Fantasy worlds
3. Real world
4. Inside the human body

7. Intended outcomes
1. Knowledge gain; deeper understanding
2. Skill development and rehearsal
 Health decision-making
 Self-care
 What to do in social situations
3. Changes in attitudes, risk
perceptions, empathy, self-concepts – all can lead
to behavior change
4. Social support – instrumental and emotional
5. Motivation for health behavior change in real life

8. Repurposed off-the-shelf commercial games
could be used for chronic conditions
 Aerobic fitness and weight loss
Dance games, Wii Fit, Kinect games
 Mental acuity, attention, memory
Scrabble, Sudoku, Tetris, Dakim, Brain Age
 Physical therapy and rehabilitation
Wii balance board, Kinect motion sensor
 Phobia reduction
Auto racing games to address fear of
driving

9. Theory integrated into the game design
 For example, Extended Parallel Process Model (Witte)
 Game presents a threat message
 Players feel threat of the chronic condition:
 Perceived severity, susceptibility
 Game instills efficacy through rehearsal of self-
management
 Players see the efficacy of the recommended response as
they rehearse that response
 Self-efficacy, response efficacy

10. R2 = .03
Perceived
susceptibility
.18* .35***
R2 = .15
). Perceived
severity R2 = .19
Playing
the health game Improved behaviors
.20** .35*** and health outcomes
R2 = .05
Self efficacy for
self-management
behaviors .17**
-.11**
.28***
R2 = .08
Response efficacy of
self-management
behaviors

11. Here are examples of games for
management of chronic conditions
 The Diabetic Dog (diabetes)
 Re-Mission (cancer)
 Bronkie the Bronchiasaurus (asthma)
 Heart Sense (heart disease)

12. The Diabetic Dog

13. The Diabetic Dog
 Nurturing of a “patient” character
 Simulation of chronic disease self-management
 Underlying multivariate algorithm of actions and
effects
 Make health decisions and see the consequences
 The nurtured character’s health outcomes (good
outcomes are needed to win the game) are based
on the player’s health decisions in the game

14. Bronkie the Bronchiasaurus

15. Bronkie the Bronchiasaurus
 Role playing adventure game
 Fantasy characters
 Set in the real world (real consequences of good
or bad asthma self-management)
 Nurturing of one’s own character
 The character’s health outcomes (good outcomes
are needed to win the game) are based on the
player’s health decisions in the game

16. Re-Mission
 Produced by HopeLab, Palo
Alto, CA
 For teens and young adults
who have cancer
 To improve cancer
knowledge, adherence, sel
f-care

17. Re-Mission
 Role playing adventure game
 Fantasy characters
 Set in the human body
 Nurturing of characters
 The nurtured character’s health outcomes (good
outcomes are needed to win the game) are based
on the player’s health decisions in the game

18. Heart Sense

19. Heart Sense
 “Role playing game in which you help the hero try to
solve a crime and simultaneously rescue his career
and find romance. However, as the hero, some of the
many characters you might get clues from, need your
help to deal with heart attacks before they or others
can help you. Since, for their own reasons, they often
don't believe they are having a heart attack or don't
want to take care of it promptly, there are significant
obstacles to helping these characters help
themselves. And if you prefer to harm these
characters, you are free to do so, but watch out, your
own future will be affected as well!”

20. Heart Sense
 Role playing adventure game
 Realistic characters
 Set in the real world
 Nurturing of characters
 The nurtured character’s health outcomes (good
outcomes are needed to win the game) are based
on the player’s health decisions in the game

21. Research examples
Re-Mission, Bronkie
Randomized controlled trials
(no slides, just speaker’s description)

22.  Do you recommend any disease
self-management games with
different formats and behavior
change strategies?
 Innovative ideas for designing
disease self-management games?

23. Thank you!
Debra Lieberman, Erica Biely,
Ramsey Nijem, Marta Delcor
Health Games Research
UC Santa Barbara
www.healthgamesresearch.org
Database: www.healthgamesresearch.org/db