Review and special article
Playing for Real: Video Games and Stories for Health-Related Behavior Change

https://doi.org/10.1016/j.amepre.2007.09.027Get rights and content

Background

Video games provide extensive player involvement for large numbers of children and adults, and thereby provide a channel for delivering health behavior change experiences and messages in an engaging and entertaining format.

Method

Twenty-seven articles were identified on 25 video games that promoted health-related behavior change through December 2006.

Results

Most of the articles demonstrated positive health-related changes from playing the video games. Variability in what was reported about the games and measures employed precluded systematically relating characteristics of the games to outcomes. Many of these games merged the immersive, attention-maintaining properties of stories and fantasy, the engaging properties of interactivity, and behavior-change technology (e.g., tailored messages, goal setting). Stories in video games allow for modeling, vicarious identifying experiences, and learning a story’s “moral,” among other change possibilities.

Conclusions

Research is needed on the optimal use of game-based stories, fantasy, interactivity, and behavior change technology in promoting health-related behavior change.

Section snippets

Background

Usual school health curricular and other behavior-change interventions targeted at children have had limited effectiveness.1, 2 New channels are needed to reach children that offer promise of promoting substantial health-related behavior changes. One such new channel is the video game, since many children spend numerous hours playing them.3 Using video games to promote behavior change could capitalize on the children’s pre-existing attention to and enjoyment of them. No review has appeared of

Methods

A search was conducted for publications on video games for health-related behavior change by searching the authors’ personal files, contacting colleagues at professional meetings, and searching the following terms in PubMed: games, video games, and interactive multimedia, as well as combinations of these terms. Inclusionary criteria included using the word game to describe their software, with the goal of attempting to modify lifestyle behavior change. Exclusionary criteria were interactive

Results

There was substantial variability across studies in their design, the targets for change, and the characteristics (and reporting of characteristics) of the games. The two-group (treatment versus control) randomized clinical trial (RCT) was the most common outcome evaluation design, but several were single-group-only. Four of the physical-activity video game studies tested primarily whether the game offered the possibility of enhancing fitness,24, 25, 26, 27, 28, 29 with only two assessing

Discussion

Playing most of these behavior-change video games led to a broad spectrum of desirable outcomes from knowledge increases,32 to attitude changes,36 behavior changes,34 and other health-related38 changes. This bodes well for the future use of video games to promote health-related behavior changes and warrants an intensive analysis of aspects of video games that offer the most promise of promoting behavior change. There appear to be two primary methods by which video games can influence behavior.

Conclusion

Serious video game–based behavior change is an exciting form of media-based intervention. A peer-reviewed literature is emerging on this topic. The many desirable outcomes warrant moving forward in this area. A second generation of research requires models of pathways of effects, and testing theory-based propositions. This should include how to use story to affect variables on the pathways to change. Understanding how to harness the power of media-based video game interventions offers great

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