The Five Most Important Research Issues in Effective Game for Health Design (from a Behavioral Scientist's Perspective)

Games for Health are a relatively new genre of games and an innovative intervention method for changing behavior to promote health or prevent disease. At the current time, most children and many adults wish to be entertained, not educated or "talked at". Video games which can be entertaining, thereby, provide an ideal modality for influencing health related behaviors. Given the recency of the genre, however, it is not clear how best to design video games to change behavior.

The mediating variable model has been proposed as a conceptual model for understanding how behavior changes occur. Understanding how video games may influence behavior and health introduces a new variable, game play, into the mediating variable model.

Adults and children generally play games in general, and video games in particular, because they are "fun". Approximately equivalent terms are "enjoyable" or "engaging". The concept of "fun" (or its related constructs) has not been precisely defined, nor operationalized. Psychosocial, physiological, and embodiment approaches to studying fun have been attempted, but not thoroughly researched. Better understanding is needed of what in the experience of video game play constitutes fun, and the relationships among the psychosocial, physiological, and related constructs and methods. This should enhance the design of video games for health, by enhancing the players' desire to continue game play, and thereby increasing the game players' exposure to the change inducing elements.

Stories, or narratives, have been incorporated into many video games for health. Stories have been hypothesized to "transport" the player out of their attention to their immediate surroundings, or "immerse" the player in the story line, thereby enhancing the player's attention to messages or other intervention procedures embedded in the story, e.g. character modeling of desired behaviors. Cutscenes within games can be used to advance the storyline or stories can be used separate from the games (e.g. in parallel books). Better understanding of a) how stories immerse players should lead to stories which are more effective at influencing behavior; b) how to use stories in, or in parallel to, game play should enhance immersion; and c) which behavior change procedures, and how, to insert them in stories, should enhance resulting mediating variable and behavior change.