School is out and summer is here! For many kids, this means replacing 6 hours of school with 6 hours of video games. Although a utopia for many teenage boys and even many teen girls (97% of teens age 12–17 play video games), this extra time spent in front of a screen is often viewed by public health practitioners and parents as a tragedy. However, a new type of game has emerged—games with purpose beyond entertainment or “serious” games—and, with more evidence surfacing every day about their effectiveness, we can now actually encourage our kids to play games. With increasing awareness of the childhood obesity epidemic and the growing innovation behind games designed to improve health, it may not be so difficult to get our kids active during summer break!
Health behaviors, especially physical activity, can be very difficult to change. These behaviors are learned over a lifetime and are influenced by a range of factors, including environment, family, social norms, awareness, and more. To overcome such barriers, public health practitioners are partnering with gaming experts and behavioral scientists. Together, they are developing new, innovative strategies to increase physical activity and improve health through games—and it’s working!
Zamzee, created by HopeLab to combat childhood obesity and prevent chronic disease, is one such game making significant strides in increasing children’s physical activity levels. Zamzee is a small device that kids carry with them throughout the day to measure their physical activity. The device then communicates with a gamified website that displays the child’s physical activity data, provides points based on the amount of movement, and allows kids to select rewards. HopeLab, in partnership with the Robert Wood Johnson Foundation, completed a dozen scientific studies on Zamzee and found that the game increased physical activity by 59 percent and improved risk factors associated with chronic diseases.
So, how does it work? HopeLab explains the outcomes through their focus on both extrinsic and intrinsic rewards. The extrinsic rewards, points and gift cards, help motivate kids to initiate physical activity, while the intrinsic rewards, the positive experiences children gain through physical activity and participation in Zamzee, help sustain the behavior change over time. In other words, these rewards work to increase perceived benefits and reduce perceived barriers—determinants of behavior change in the Health Belief Model, a behavior change theory widely used in the public health field. The extrinsic rewards and intrinsic rewards, such as successfully becoming more active (mastery), achieving goals (purpose), and interacting with similar users (relatedness) increase the perceived benefits of physical activity. Other intrinsic rewards, like feeling confident in one’s abilities (competence) and gaining independence (autonomy) reduce the perceived barriers to physical activity. Together, these rewards increase the likelihood that the user will engage in a preventive health behavior, physical activity in this case.
In a study on exergames conducted by Georgetown University and sponsored by the Robert Wood Johnson Foundation, scientists found similarly encouraging results. Exergames, which have become quite popular, are a category of video games like Nintendo’s Wii EA Sports Active that require physical activity to play. The study examined health impacts in overweight and obese high school students who regularly participated in exergames. Results showed that students who engaged in cooperative exergames lost an average of 3.6 pounds over the 20-week study period versus the control group, which gained an average of 1.9 pounds.
Again, these results can be explained through the constructs of behavior change theory. The Theory of Planned Behavior, another behavior change model popular in public health work, identifies intention as the predecessor to action. The theory outlines three determinants of intention, including an individual’s beliefs about the actual behavior, what they perceive other people believe about the behavior (subjective norm), and their perceived ability to perform the behavior. Students in this study gained self-efficacy through successfully becoming more active, and peer support by participating in cooperative games as opposed to competitive games. These factors improved perceived behavior control and the subjective norm, respectively. Together, these changes influenced the students’ intention, which ultimately determined their behavior.
Games increasing physical activity in children are only the beginning; many other audiences and health issues are the target of games currently in the market. Lumosity, a game created for all ages to promote brain health, has been shown to improve brain functions, such as cognition and memory, among others. Re-Mission, another game created and extensively studied by HopeLab, is a game that improves childhood cancer outcomes by helping kids adhere to their treatment plans. A 2008 randomized control trial of Re-Mission showed increases in both knowledge and self-efficacy by playing the game, and a recent 2012 brain-imaging study showed increased neural responses that are typically associated with reward and positive motivation. And one of my favorites, Zombies, Run!, motivates players to run, in real life, as they try to escape a quickly approaching, virtual zombie attack.
The field of serious games has great potential to impact public health, especially with the current vast adoption of mobile, self-tracking, and movement-sensing technologies. To successfully create a game that achieves behavior change and impacts health status, evidence-based behavior change models must inform its design. The serious games movement is demonstrating how the difficulties of behavior change can be overcome through creative application of theory and innovation in an already successful field. So before we ban our kids from video games during the summer months, let’s look into what games might keep them entertained while also improving their health!
Our mission here at Danya is to provide innovative solutions for social impact. We work to provide products and services that meet user needs and expectations and operate with technology already in use. As the field of serious games continues to expand, Danya will certainly be looking for opportunities to incorporate this innovative solution to achieve meaningful, public health impact.
By Katie Mooney