Games for Health 2013, validation of serious games as a medium or means?
By Katinka van der Kooij
Last week, the annual conference Games for Health took place. The ambitions were grand and uniform: games have to make us happier and cheaper. The miracle drug often appeared to be an existing therapy summarized on a 2D screen, enriched with scores and fantasy elements. Researchers were asked to conduct validation studies, transforming these miracle drugs into accepted solutions.
Validation of serious games in health care
But what does validating a serious game mean and what can validation contribute to the development of serious games? Subject of a symposium and Games for Health keynote by Evert Hoogendoorn.
Before a meaningful discussion about validation of serious games can be started, it has to be clear exactly which claims have to be validated. In many cases it appeared to be a method to prove that a game had lived up to the ambitions of its developers. When those ambitions lie in improving health care, methods to assess new medication or treatments with are often used. A research proposal is carefully assessed by a medical ethics committee and about six months later a large-scale experiment is started with patients in a random controlled trial. Before a subtle but significant change in our complex behaviour can be demonstrated with statistical certainty, a large number of human subjects have to be studied for a long period of time. A procedure that will easily take up years and that does not tie in with the rapid developments of digital media.
Validation of principles instead of games
In his keynote speech, Evert Hogendoorn suggests to no longer validate a game as a whole, but to develop a game based on validated principles. That way a game can be put on the market reasonably quickly and the participants in a validation study are not exposed to a product of which the effects are uncertain. An audience member wanted to know what a validated principle is. An important question. In my opinion a validated principle is a game mechanic of which the effect on the player has been quantifiably proven. An example is operant conditioning. Pavlov’s experiments have shown that when the availability of food is always accompanied by the sound of a bell, dogs learn to react to the bell the same way as they would to food. Psychological experiments have shown numerous varieties that prove that an event (‘stimulus’) can have a positive or negative connotation by linking it to a familiar stimulus. Such a principle can be used in a game to reduce the affective connotation of, for instance, a phobic stimulus. So, a validated principle is no more than a radar in the game that influences a component in our behaviour. Validation of principles does not enable developers to support the ambitions of their games with concrete data. Based on existing theories it can, however, be argued convincingly that tinkering with a component in our behaviour clears the way for more complex behavioural changes. In collaboration with IJsfontein, the Delft University of Technology and Brijder Addict Care, I am working on a case in which we encourage treatment fidelity of young people with a cannabis addiction by means of a game. When we show that young people make their homework more often because the game mechanics incite them to do so, we have not proved that our game is an effective means against a cannabis addiction. We do show, however, that we offer a significant contribution to the effectiveness in which Brijder Addict Care offers their patients treatment validated by psychologists. In my opinion great ambitions are in order in the creative design process and marketing of a serious game, but they cripple the validation process because they force the developers to test a behavioural change that cannot be measured.
Validation of games as a means
When we regard games as a means to influence the user’s behaviour through validated principles, the validation matter changes. We no longer have to support the ambitions of entire games. We do have to prove that a principle in the game medium works the way it works in the context it has be researched in. Research that provides general information for the design of serious games. Take rehabilitation games, for example: do we learn natural movements just as well based on feedback from a flat screen as based on feedback from a physical therapist, who is with us in the three-dimensional space? And will young people keep a diary differently when they have been motivated by a game or intrinsically? These are all questions from research projects I am working on with IJsfontein.
Katinka van der Kooij is doing post-doctoraal research at the Delft University of Technology and the VU University Amsterdam. With IJsfontein she is working on a game to support treatment fidelity of young people addicted to cannabis. In addition, she is doing research on how fundamental scientific knowledge on how to learn movements can be applied in rehabilitation games. A project in which IJsfontein participates in a user committee.