Why it Works
Game Effectiveness for Healthy Lifestyle Change
Serious digital games can be effective at promoting healthy lifestyle change1,2. For example, a meta-analysis of 54 studies of health-promoting serious games found that lifestyles improved significantly (g=0.260, 95% CI 0.148; 0.373) as did clinical outcomes (g=0.079, 95% CI 0.038; 0.120).2 Games having a sound theoretical foundation in behavioral change and effective game design was most effective.2 Merging the immersive, attention-maintaining properties of stories and fantasy, the engaging properties of interactivity, and behavior-change principles, such as tailored messages and goal setting, contributes to game effectiveness.
Effective Game Design
Game design components shown to be the most effective at producing healthy lifestyle change can be adopted and combined to increase the likely effectiveness of a new game. The following components have been described as being effective in games for obesity management and prevention:
- Provide a foundation of knowledge and skill for behavior change3
- Encourage personal mastery and offer avatars to personalize the experience3
- Demonstrate the desired change for observational learning3
- Have players make a personal plan for changing their behavior4
- Make the game fun! This most important element includes dramatic tension, humor, and challenge3
- Emphasize increasing good behavior over decreasing bad behavior, because the latter is more difficult to achieve2
Tailoring the Experience
Tailoring the game experience is another game component that is important in serious games for a lifestyle change. Tailoring to the individual helps to attract player attention and support information processing. Serious game experiences should be tailored according to:
- The player’s specific need for lifestyle change1,2
- The player’s game skill level1,2
- The player’s individual preference1,2
An example of tailoring to the individual player is providing game messages according to the player’s personal information or personal goals, set before playing.3 In Food Fight, for example, future versions will allow the user to tailor their experience according to the specific diet they wish to follow, such as low-carbohydrate or the Paleo diet.
How Food Fight Works
Food Fight utilizes two components of behavioral therapy in order to achieve lifestyle change – Refusal Skills Practice and Counter Conditioning.
- Refusal Skills Practice is a component of Cognitive Behavioral Therapy (CBT) that has been used effectively in addiction treatment5. In Refusal Skills Practice, individuals learn how to respond rapidly with a clear, assertive “No”, in response to an offer of a substance that they are trying to quit6. Applying this approach to enhancing healthy eating, players in Food Fight, refuse foods by throwing them back, which corresponds to saying “No” in Refusal Skills Practice.
- In Counter Conditioning, an unwanted behavior is replaced with a positive action and the new behavior is rewarded7. In Food Fight, the habitual, unwanted (but pleasantly rewarding) behavior of eating high calorie, unhealthy foods is counter-conditioned by receiving game rewards for rejecting these foods and throwing them back. Visuals showing the unhealthy foods being destroyed, as they are rejected, add to feeling empowered to resist tempting foods. Repeating these actions many times through repeated play has a rehearsal effect, which helps build new habits.
- Baranowski T, Buday R, Thompson DI, Baranowski J. Playing for Real: Video Games and Stories for Health-Related Behavior Change. Am J Prev Med. 2008;34(1):74-82.e10. http://www.sciencedirect.com/science/article/pii/S0749379707006472. Accessed September 10, 2016 doi:10.1016/j.amepre.2007.09.027.
- DeSmet A, Van Ryckeghem D, Compernolle S, et al. A meta-analysis of serious digital games for healthy lifestyle promotion. Prev Med. 2014;69:95-107. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4403732/. doi:10.1016/j.ypmed.2014.08.026.
- Thompson D. Designing Serious Video Games for Health Behavior Change: Current Status and Future Directions J Diabetes Sci Technol. 2012;6(4):807-811.
- Thompson D, Bhatt R, Vazquez I, et al. Creating action plans in a serious video game increases and maintains child fruit-vegetable intake: a randomized controlled trial. Int J Behav Nutr Phys Act. 2015;12. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4372224/. Accessed November 30, 2017 doi:10.1186/s12966-015-0199-z.
- Witkiewitz K, Villarroel NA, Hartzler B, Donovan DM. Drinking outcomes following drink refusal skills training: differential effects for African American and non-Hispanic White clients. Psychol Addict Behav. 2011;25(1):162-167. doi:10.1037/a0022254.
- Carroll, K.M.. A Cognitive-Behavioral Approach: Treating Cocaine Addiction Therapy Manuals for Drug Abuse: Manual 1. NIDA; 1998.http://archives.drugabuse.gov/TXManuals/CBT/CBT10.html.
- O’Brien CP, Childress AR, McLellan T, Ehrman R. Integrating systemic cue exposure with standard treatment in recovering drug dependent patients. Addict Behav. 1990; (15):355-65. https://www.ncbi.nlm.nih.gov/pubmed/2248109.