This presentation was offered as a talk at Ludica Medica for the Games for Health Conference 2011. The talk emphasizes assessment, measurement, and evaluation utilizing the MTMM model for statistical analysis of construct validity and roi measures.

1. Game Design for Return on Investment The review, planning, and production of a digital training tool for long-term care certified nursing assistants Brock Dubbels Center for Cognitive Sciences The University of Minnesota Brock@vgAlt.com

2. What I’m Playing...

3. Why games for learning? Games, by their very nature, assess, measure, and evaluate. But, you still need to know what you are assessing, measuring, and evaluating. Assessing inside and out of the game. The creation of construct validity and method.

4. Topics Yoga – perceptual / conceptual -- activity Background The game Development talking points Take home

5. The state of long term care 55% white, 35% Black, 10% Hispanic Most workers are economically disadvantaged Low levels of educational attainment. Physically and emotionally demanding work, but often among the lowest paid in the service industry. Viewed as an unpleasant occupation: primarily a maid service taking care of incontinent, cognitively unaware old people. 45% attrition rate in first 90 days. Some reports show 100% turn over a year. Great shortage—with shortages, come reductions in quality of care. Expected growth rate of 85% with Baby Boomers retiring. Regulation tends to emphasize entry training, with limited attention to continued career growth or development. Supervisors with “good people skills,” promotion of worker autonomy are the most important predictors of higher job satisfaction and lower turnover rates. From “Who Will Care for Us?” US Dept. Health & Human Services

6. Hypothesis Will improved people skills and increased worker autonomy reduce attrition through improving the perceived quality of life. Will perceived quality of life improve relations and autonomy in the facility? Increase well-being in residents and nursing assistants? Reduce pain management? Reduce catastrophic care? Confidence and accuracy in information gathering and reporting?

7. The User Story Functionally capable, but not skilled. Soft skills Documentation skills High school education +/-1 Like popular culture. A bit irreverent about job, but this is coffee break coping mechanism Limited care load while training. Enjoy popular culture – soaps, drama, etc.

8. Pre-Design Methods Elicitation – do you really need a game? Cognitive Ethnography Identification of quality of life variables, theoretic processes (presence, CC, AL), & documentation variables for kiosk. Fidelity Assessment, measurement, and evaluation methods.

9. Design Decisions FPH –the first person healer Flash / with database Web-host as well as installed with data upload. Time serves as game element Functional task selection vs. Interpersonal Communication Dialog driven Dialog supported by video cut scenes with voice narration Mini games such as room clean up Reward system (blue stars) Preceptor / Optimal Path / Debrief Interface with task log, resident information, clock, pause. Use real people’s faces as avatars Increase engagement through subtle but tasteful irreverence.

11. Task List

12. Profile: Al

13. Profile Eunice

14. Kiosk

15. Branching Dialog Blue star for Constructive Conversation— you constructively redirected.

16. Interaction

17. Rooms

18. Debrief

19. Four questions Can I take any credit for any changes that have happened in an individuals learning? Does this have a connection to my instructional activities? Does these instructional activities equate to a return on investment? How do I know this?

20. Tension in workflow Software Design Typically based upon an economic consideration. How will this solve a problem? What are the first steps in production? The focus is on stages of production: Business Partner Relations, Function, Behavior, Structure, & Non-Function (qualities). Research Design Typically based upon answering a testable question. How will this solve a problem? How do I know this? The focus is on method and hypothesis testing: Construct validity, reliability, reliability, and probability.

21. Theoretical perspective Improve soft skills and documentation. Quality of Life Measures How these are affected through: Presence, Constructive Conversation, Active Listening These are used for game mechanics and coding dialog. Reducing attrition, improving Perceived Quality of Life (PQoL), and improving documentation will reduce costs and allow for more hires, better wages Reduce: pain meds, attendant care, catastrophic care. Documentation Reduce elicitation from medical staff Improve medical staff objective knowledge on daily living skills

22. Analysis Tools In order to measure whether the game does what it was designed to do: Analysis criteria must exist inside and outside of the game for evaluation. Same underlying measures from game Inside: Scoring system weighted dialog Story content equated to kiosk input Outside: Observational scoring tool for preceptors Survey for self-report Resident survey

23. Construct Validity—How do we know what we measure means anything? MTMM to measure convergent/discriminatory validity. You need 3 measures for construct validity measures. In-game measures Observational workplace rubric Resident survey Without construct validity, you cannot conduct ROI analysis with certainty.

24. Cognitive Ethnography Design/ Usability Perspectives for MTMM validity measure

25. Mental Representation

26. Outcome Analysis General Linear Model Quality of Life Variables Operationalized in soft skills and PQoL construct Presence, Active Listening, and Constructive Conversation Longitudinal study Pre, Game Play, Post Compare performance in: surveys, objective observer data, game play, non-game play controls, self-report. Game play – construct sub-level scoring, i.e. number of residents, rewards, optimal path decisions. Institutional data pre / post Compare catastrophic care, pain meds, independence, attrition Use game play, survey and observational tools as co-variates.

27. Take home Can you pose a testable question– hypothesis? Tension between design process and measurement Needs – behavior, function, non-function, structure. Construct validity – are you measuring what you think you are measuring? Assessments, measures, & evaluations Spend time understanding the sample population Beliefs, likes, skills, & abilities. irreverence increases engagement, but reduces happiness of business partner. Usability testing should align with construct Again, emphasis on validity Without it, there is no capability for ROI analysis