This talk discusses evidence-based game design strategies that can be integrated into health games to help make them more engaging, motivating, and efffective at supporting health behavior change.

1. Designing Games to
Improve Health Behaviors:
Evidence-based Principles and Strategies
Presentation:
Games for Change Festival, New York
Debra Lieberman, Ph.D.
Director, Center for Digital Games Research
UC Santa Barbara
June 28, 2018

2. Games
Interactive, adaptive, immersive,
impactful experiences
Challenge to reach a goal
Feedback on progress
New platforms, displays,
sensors, data sources

3. Media are similar to real life
 We feel “present” in media worlds
 Games can have compelling stories and
characters, interactions, transactions,
simulations, constructions, collaborations,
social connections with other people
 Games can be embodied in robots, plush toys
 We experience media events
 Our emotional responses to media events and
events in real life are remarkably similar

4. Researcher’s role in game design
 Specify the game concept and goals
 Evidence-based game design strategies to achieve goals
 Proposals for grants, investments, gifts
 Play testing and game revision during production
 Evaluation research to measure outcomes
 Publish and present evaluation research findings
 Help the design team keep up with current research

5. (1) Specify the game concept and goals
Know target players
 Interests, abilities, culture
 Self-concepts
 Game platforms & genres they prefer
 Formal or informal setting for game play
 Current health behaviors and health risks
 Barriers to good health behaviors (lifestyle, prevention, self-care)
 Do they want to improve this health behavior? Why or why not?
 (Players should be design partners!)

6. (2) Specify the game concept and goals
Behavioral wish-list from medical experts
 Patient behaviors that must change
 What patients need to know/understand
 Attitudes that patients could change
 Self-concepts that would benefit patients
 What motivates patients to improve behaviors

7. (3) Specify the game concept and goals
Which behaviors  Game goals and
can a game improve? intended outcomes

8. Focus the design on specific outcomes
How will game play enhance the outcomes?
Standalone game or integrated with other media,
games, or direct experiences?
 Must one game achieve all outcomes?

9. Mediating factors can change behavior
Game  Mediating  Behavior  Health
factor outcome
Examples of mediating factors
 Perceived susceptibility
 Perceived stigma
 Skill development
 Self-efficacy; response efficacy

10. From Interactive Games to Outcomes
Game playing  Improved mediating factors  Improved outcomes
Better
health
behaviors
• Prevention
• Selfcare
• Adherence
• Clinical
utilization
Better
health
Better
quality of
life
Lower
healthcare
costs
Health
video
games
• Challenge
• Motivation
• Role models
• Simulations
• Repetition
• Feedback
Self-concepts
Communication
&
social support
Knowledge
&
skills
Self-efficacy

11. Evidence-based design
Draws from theory and research findings to improve:
 Engagement
 Motivation
 Attitude change
 Self-concept change
 Learning
 Skill development
 Behavior change

12. Engagement
Elaboration Likelihood Model
 (ELM) – Involvement
Transportation Theory
Homophily
 Attention to characters like me
Self-referential encoding
 Learn as the content pertains to me
Tailoring, personalization,
adaptiveness, feedback

13. Social connection is
engaging
Self Determination Theory
Social comparison (leaderboard)
Social support, coaching
Teach a character

14. Motivation
Extrinsic / Intrinsic
 Points, level-ups vs. deep personal goals
 Different messaging for each
 Tie them together
Game challenge is motivating
 In the game and in daily life behaviors
See yourself as avatar
 Self-modeling – exercise and lose
weight – transfers to actual exercise
 Future self – save more for retirement

15. Attitude change
Empathy
 Your avatar cannot avoid homelessness
 Your avatar struggles with health issue
Procedural rhetoric
Vicarious experience – Re-Mission
 Social Cognitive Theory
 Improves self-efficacy for cancer care
 Players without cancer now see it as a
serious problem – inspired to improve
lifestyle habits

16. Self-concept change
Rehearsal  Self-efficacy
Role modeling
Feedback on success
Avatar of self
 Experiment with new identities
and feel empathy
 Aspirational avatar, project one’s
ideal identity and experience it
 The Proteus Effect

17. Learning and skill development
Simulations of real-life challenges
 Climate games – use resources
wisely or not – see consequences
 Health games –treat a patient (or self
as avatar) – see effects
Feedback tied to interests, values
Become your avatar
 Hellblade challenges the player to
think like a psychotic, in order to win

18. Behavior change
Rehearsal of habits, skills, adherence
Game as springboard for discussion
Two-player, cooperative challenges
Stages of Change – five stages
 Player segmentation
Inspired, mobile game, quit smoking
 External accountability
 Friends hold you accountable
 Friends cheer you on, celebrate

19. Behavior change – sensors
Mindlight, for anxiety-disordered
children ages 8-12
 Players must overcome their fears
 Neurofeedback headset
 Respond to scary events, threats
 Practice relaxation, focus, attention
allocation
 Develop new habits of mind

20. Behavior change – narrative
Dramatic stories are engaging,
arousing, transporting, memorable
 We care about the characters
 First-hand experience when our own
avatar is a character
 Emotional and physiological responses
 Stories enhance attention, immersion,
persuasion, learning, skill transfer, recall
of facts

21. Behavior change – neurogames
diagnose, treat, and assess cognition
 Project Evo for ADHD – improves
attention and control
 Storytelling and feedback
 Challenges and rehearses neural
systems
 Adapts to player’s abilities
 FDA approval

22. Behavior change – active games
Require physical activity
 Physical activity is the interface
 Or real-world activities supported
by mobile content, AR, VR, robots
 Can improve physical activity
habits, social connections,
cognitive functioning, cardio-
vascular health
 Tele-rehabilitation

23. Behavior change – social

24. Behavior change – social

25. Behavior change – inter-generational

26. Behavior change – better communication
with medical team about health concerns

27. A few overarching principles and strategies
Didactic content is the least of it
Player experience is key – in the game and outside it
Focus on a few specific goals for behavior change
 Be redundant – design several game features and game mechanics to
address each goal
Address player’s intrinsic values and motivations
Iterative testing and redesign are essential
A game can be fun and effective – don’t squelch the fun
Learning, skill development, striving, problem-solving, failing/retrying
are fun – not stealth, not broccoli covered in chocolate sauce!

28. Proverb
Tell me and I forget.
Show me and I remember.
Involve me and I understand.

29. Thank you
Debra Lieberman, Ph.D.
Director, Center for Digital Games Research
UC Santa Barbara
debra.lieberman@ucsb.edu
www.cdgr.ucsb.edu
Twitter: @DebLieberman
Twitter: @GamesResearch