This document summarizes a webinar presented by Tom Baranowski on using games for health. It discusses how games can engage players to promote behavior change for chronic illness management and obesity prevention since traditional approaches often have low adherence. Serious games incorporate story, feedback, and rewards to motivate players. Research shows games can produce behavior changes, and several games developed by Baranowski for diet and activity are presented. Future research needs to better understand how to maximize fun in games to improve health behavior change outcomes.

1. Pediatrics
NIDDK
NATIONAL INSTITUTE OF
DIABETES AND
DIGESTIVE
AND KIDNEY DISEASES
NATIONAL INSTITUTE
OF HEALTH
Eunice Kennedy Shriver
NICH
D
HP Live - Webinar May 17, 2013 – 11:00 am CDT
Professor of Pediatrics (Behavioral Nutrition & PA)
USDA/ARS Children’s Nutrition Research Center
Baylor College of Medicine
Houston, Texas, 77030, USA
www.bcm.edu/cnrc/faculty/?PMID=9519
Games for Health
with
Tom Baranowski, PhD

2. Games for Health
HP Live – Webinar
May 17, 2013 – 11:00am CDT
Chronic Illnesses/Obesity Treatment
• Regimen Adherence has been low
– often 50% or less
Chronic Illnesses/Obesity Prevention
• Behavior Change has been small
– if at all
Need alternatives to usual approaches?

3. Games for Health
HP Live – Webinar
May 17, 2013 – 11:00am CDT
Videogames (Serious VG/VG for Health)
• Have story and interactivity to
engage/immerse/transport players
• Can incorporate behavior change or health
change procedures
• Can incorporate feedback and rewards to
motivate change
• Has “fun” to maintain game play

4. Games for Health
HP Live – Webinar
May 17, 2013 – 11:00am CDT
“Playing for Real” (Baranowski et al AJPM 2008)
• All 28 games reviewed showed evidence of
change in the desired direction
• We have developed and evaluated several
games for health

5. Games for Health
HP Live – Webinar
May 17, 2013 – 11:00am CDT
Diab Trailer

6. Games for Health
HP Live – Webinar
May 17, 2013 – 11:00am CDT
Preliminary Process Model of
Behavior Change from Games
Demographics
Pregame
Characteristics
Motivation
to Play
Video
Game
PsychosocialVariables:
Motivation to
Continue Playing
Game
Exposure
to Video
Game
Immersion
Success?
Fun?
Practical
Knowledge
of Behavior
for Change
Behavior
Change
Skill
Development
Behavioral
Self Control
Skill
Development
- Include Asking
Motivation
to Change
Behavior
Physical
Resources
Barriers to
Change
Behavior
Change
Attempts
Continued
Behavior
Change
Attempts
HabitSuccess
Fun?
Challenging
Success
…Time…
Home
Accessibility/Availability
Attention
to Video
Game
Activities
Central
Processing

7. Games for Health
HP Live – Webinar
May 17, 2013 – 11:00am CDT
Model Incorporates Elements of:
• Self Determination Theory
• Elaboration Likelihood Model
• Social Cognitive Theory
• Transportation Theory (Immersion)

8. Games for Health
HP Live – Webinar
May 17, 2013 – 11:00am CDT
Process Model of Possible Mechanisms for
Children’s Dietary and Physical Activity Change in
Video Games
Demographics
Pregame
Characteristics
Motivation
to Play
Video
Game
PsychosocialVariables:
Game Activities:
Motivation to
Continue Playing
Game
Exposure
to Video
Game
Immersion
Attention
to Video
Game
Activities
Success?
Fun?
Practical
Knowledge
of Behavior
for Change
Story
-Modeling
Behavior
-Modeling
Overcoming
Barriers
- Moral of Story
Behavior
Change
Skill
Development
Behavioral
Self Control
Skill
Development
- Include Asking
Simulation
with Feedback
Motivation
to Change
Behavior
Self Control
Activities
-Goal Setting
• action
• coping
-Problem
Solving
-Automation
Physical
Resources
Barriers to
Change
Behavioral
Innoculation
Procedures
Behavior
Change
Attempts
Tailored Motivational
Messages
-Outcome Expectancy
-Values/Reasons
Continued
Behavior
Change
Attempts
HabitSuccess
Knowledge
Games
Fun? Challenging
Success
Central
Processing
…Time…
Home
Accessibility/Availability

9. Games for Health
HP Live – Webinar
May 17, 2013 – 11:00am CDT
Squire’s Quest!

10. Games for Health
HP Live – Webinar
May 17, 2013 – 11:00am CDT
Squire’s Quest! Evaluation Design
• 1600 4th grade students in 26 schools
• Cluster randomized trial
• Pre & post assessment
• Multiple 24hour recalls – FIRSSt
• Treatment: SQ!; no intervention control

11. Games for Health
HP Live – Webinar
May 17, 2013 – 11:00am CDT
Squire’s Quest! Outcomes
• Increased FV intake by 0.9 servings
• Changes occurred at snacks (fruit), lunch
(vegetable)
– Need more work on breakfast, dinner
• Attain recipe prep goals → more FV consumption

12. Games for Health
HP Live – Webinar
May 17, 2013 – 11:00am CDT
GEMS – Fun Food & Fitness

13. Games for Health
HP Live – Webinar
May 17, 2013 – 11:00am CDT
Boy Scout 5-A-Day & FFL Badges

14. Games for Health
HP Live – Webinar
May 17, 2013 – 11:00am CDT
Fit For Life Boy Scout Badge Program
(R Jago et al Prev Med 2006)
• Meeting + internet based
– Skill building
– Comic character modeling + goal setting
• Spring intervention
– + 12 minutes LPA
– - 12 minutes SB
• Not fall intervention (?)

15. Games for Health
HP Live – Webinar
May 17, 2013 – 11:00am CDT
Escape from Diab

16. Games for Health
HP Live – Webinar
May 17, 2013 – 11:00am CDT
Nanoswarm: Invasion from Inner Space

17. Games for Health
HP Live – Webinar
May 17, 2013 – 11:00am CDT
Diab/Nanoswarm Outcomes
• + 1.0/+0.67 FV serving at 2 months post
(p<0.000)
• + 7/0 min MVPA at immediate post (p=0.107)
• No differences in BMI or mediators
• No moderators
• 80-90% enjoyed playing Diab/Nano

18. Games for Health
HP Live – Webinar
May 17, 2013 – 11:00am CDT
Active Video games – Wii Study

19. Games for Health
HP Live – Webinar
May 17, 2013 – 11:00am CDT
Active Video Games – Wii Study Design
l Stratified by mother reported neighborhood safety (not
working)
l 7 days accelerometer readings at 5 times
l Children keep Wii console if provide complete data
l No differences across groups or time
l 700+ media releases around the world
AV1 AV2
MidBaseline (wk 1)
Wk 6 Wk 6
Post
R
E
C
R
U
I
T
M
E
N
T
Wk 1 Wk 1
Wk 1 Wk 1Wk 6 Wk 6IV1 IV2

20. Games for Health
HP Live – Webinar
May 17, 2013 – 11:00am CDT
Parenting Game

21. Games for Health
HP Live – Webinar
May 17, 2013 – 11:00am CDT
Innovative: V Parenting Game
• “Train” Parents → Effective V Parenting
Practices
• Simulation with feed back → learn to fly planes
• Simulate interaction with child with feedback
– Child resistant to V intake
– Parent offered parenting practice options at
interaction points
• 2 effective; 2 ineffective
• Keep selecting until select effective
• See child response
– Algorithm governs interaction
– Tailor child responses to child temperament

22. Games for Health
HP Live – Webinar
May 17, 2013 – 11:00am CDT
Future Research Needs
• Just learning how to capitalize on VG
• Vary VG intervention procedures
• Vary story components to assess how story
influences immersion and attention to game
components

23. Games for Health
HP Live – Webinar
May 17, 2013 – 11:00am CDT
Future Research Needs
• Fun = IM?
– Active involvement (interactivity)?
– Overcoming challenges
– Making choices
– Observing consequences without real threat
– Increasing difficulty
– Personally relevant story & characters in
meaningful situations
• How can we maximize “fun” to maximize
health behavior change?

24. Games for Health
HP Live – Webinar
May 17, 2013 – 11:00am CDT
Games for Health Journal
Research, Development and Clinical Applications
• Only journal devoted to Games for Health
• Editorial Board
– international
– health industry
– academic
– game industry
– Government
• June 2013: Volume 2, Issue 3 (6 issues/year)
– Special issue devoted to Games and
Childhood Obesity

25. Games for Health
HP Live – Webinar
May 17, 2013 – 11:00am CDT
Recent Topics
• Reviews of the effectiveness of games for
health
• Innovative game components, e.g.
computational intelligence
• Business models for G4H
• Exergame effectiveness among seniors,
physically challenged
• Games to enhance mental health
• Game design issues to enhance health behavior
change
• Health professional training games

26. Games for Health
HP Live – Webinar
May 17, 2013 – 11:00am CDT
Dêkuji! (Czech)
DANKE! (German)
MUITO OBRIGADO! (Portuguese)
M G̀ÒI! (Chinese, Cantonese)
ARIGATŌ! (Japanese)
MERCI BEAUCOUP! (French)
MUCHAS GRACIAS! (Spanish)
SERDECZNIE DZIĘKUJĘ! (Polish)
SHUKRAN! (Arabic, Middle East)
TACK SÅMYCKET! (Swedish)
TAKK! (Norwegian)
EFcHARISTo! (Greek)
Xie Xie! (Chinese, Mandarin)
Dank u wel (Dutch)
Khawp Khun maxh! (Thai)
Grazie! (Italian)