Serious games in health care
Serious games and e-learning tools are very effective to make people aware of their behaviour and its consequences. It is, therefore, not surprising that these means are used more and more often in health care. Such universal motives as competition, collecting, social contact, status, privileges and exclusivity are utilized. By ‘playing’ for these goals people are motivated and prepared to do things they would rather not do under normal circumstances. The enthusiasm about serious gaming applications in health care seems to keep growing. And rightfully so. However, not all games achieve their goal. Designing a good game for the health care sector is not an easy task, we know that from experience. We like to share our views:
Know your target group
This may seem obvious, but it is easily overlooked in practice. A thorough preliminary study of the target group can prove to be essential for the success of the game. Knowledge of the psychological state and emotions of the target group is important. A social game in which patients can play each other while they are ashamed of their condition and would rather not talk about it, will probably not be played much. But very practical problems can be prevented by a preliminary study as well: designing a game for a smartphone when 80% of the target group does not own one, is useless.
Define the problem
Do you want patients to become better when they play your game, or do you want them to deal with their treatment more carefully? This may seem like a subtle difference at first, but it is crucial to have a clear starting point when you develop a game. For the choice of means it is also important to focus on the objective of the game. A smartphone and tablet are often considered to be the same thing, yet they have an essential difference. A smartphone usually has only one user, where a tablet has 3.7. This requires a different approach and, depending on your problem and objective, you have to make a carefully considered choice.
Involve therapists and informal caregivers
The success of a game in (addition to) therapy often hangs on the level of involvement of informal caregivers, doctors and therapists. If you succeed in involving them in the game, the chance you will succeed becomes much more likely. Now a therapist usually has regular sessions of, for instance, an hour. In between sessions there is little to no contact. By integrating a game into therapy this contact between sessions can be intensified. The sessions with the therapist do not have to be as long as before, keeping the total treatment time the same. This way, the patient receives much more attention and feedback than before.
Let go of reality
Another main pitfall is the desire to want to simulate reality so badly that the strength of the game is destroyed. Take the behaviour you want to see happen as a starting point, not the context in which this behaviour usually takes place. A good and probably known example is an experiment carried out with patients rehabilitating within research for the Centre for Playful Learning of the Utrecht School of Arts. Part of their rehabilitation was an exercise in which the hand had to be moved up and down by flipping a pen up with the fingers and catching it with the same hand. The patient experienced this exercise as boring and painful and as a result, hard to do. Isolating the behaviour and putting it in another, more ‘pleasing’ context, led to a different result. By having the patient play the game ‘Guitar Hero’, the goal was changed to playing a guitar solo as well as possible. The patient made the same movements as in the exercise and easily exceeded the number of times he had to make the movement. The patient did not experience as much pain and the exercise was considered to be fun instead of hard.
Validation and implementation
In conclusion, two practical matters determine the success of a serious game in the health care sector: validation and implementation. Validation is often an important precondition for insurers and care providers to compensate for the costs of a game or to use it in treatments. Validation is difficult because now it is often done afterwards. A client has to make a substantial investment first and then finds out afterwards if the right effect was achieved. We think this risk can be limited by starting to validate early in the development process and to base the game on validated principles where possible and to monitor that constantly.
As is common with all new means, implementation is an important factor for success. Maybe even the most important one. In practice, however, it does not get much attention. Unfortunately, we see many very good games end up on a shelf, never achieving their intended effect. This can be prevented by thinking about the implementation and communication for the game at an early stage. By actively involving users and care providers in the development of the game or experience, for instance, backing is created at an early stage.