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Cited by 428Educational Games and GamificationMobile Health and mHealth ApplicationsMedia Influence and Health

A meta-analysis of serious digital games for healthy lifestyle promotion

Open access
DeSmet, Ann, Van Ryckeghem, Dimitri, Compernolle, Sofie, Baranowski, Tom, Thompson, Debbe, Crombez, Geert, Poels, Karolien, Van Lippevelde, Wendy +4 more·2014·Preventive Medicine
DOI 10.1016/j.ypmed.2014.08.026PMC PMC4403732
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Abstract

Several systematic reviews have described health-promoting effects of serious games but so far no meta-analysis has been reported. This paper presents a meta-analysis of 54 serious digital game studies for healthy lifestyle promotion, in which we investigated the overall effectiveness of serious digital games on healthy lifestyle promotion outcomes and the role of theoretically and clinically important moderators. Findings showed serious games have small positive effects on healthy lifestyles (g=0.260, 95% CI 0.148; 0.373) and their determinants (g=0.334, 95% CI 0.260; 0.407), especially for knowledge. Effects on clinical outcomes were significant, but much smaller (g=0.079, 95% CI 0.038; 0.120). Long-term effects were maintained for all outcomes except for behavior. Serious games are best individually tailored to both socio-demographic and change need information, and benefit from a strong focus on game theories or a dual theoretical foundation in both behavioral prediction and game theories. They can be effective either as a stand-alone or multi-component programs, and appeal to populations regardless of age and gender. Given that effects of games remain heterogeneous, further exploration of which game features create larger effects are needed.

AI snapshot

Written from the paper’s full text.

TL;DR

This first meta-analysis of serious digital games for healthy lifestyle promotion found small positive effects on behavior and its determinants and very small effects on clinical outcomes. Effects were largest for knowledge, maintained at follow-up except for behavior, and moderated by tailoring and theoretical basis.

Key findings

  • Across 54 papers and 61 game evaluations, serious games improved healthy lifestyle behavior (g=0.260, 95% CI 0.148–0.373, n=314,790, k=21) and behavioral determinants (g=0.334, 95% CI 0.260–0.407, n=19,934, k=50); clinical outcomes had a very small significant effect (g=0.079, 95% CI 0.038–0.120, n=9,367, k=10).
  • At second post-test, behavior effects were smaller and failed to reach significance (p=.07), while determinants and clinical outcomes remained significant and of similar magnitude; knowledge had the largest determinant effects and approximated a moderate effect at follow-up.
  • Tailoring was a significant moderator only for determinants: games tailored to both socio-demographic and change-need information had higher effects than games tailored only to change needs/stages of adoption. A dual theoretical foundation in game-based learning and behavioral prediction theories related to higher determinant effects than behavioral prediction theories alone.
  • Implementation method, age, gender, and study quality were not significant moderators. Heterogeneity was high for behavior and determinants, and publication bias could not be ruled out for determinants (Egger’s test t(48)=6.042, p<.001; trim-and-fill adjusted g=0.179, 95% CI 0.104–0.254).

Methods

  • Systematic search of Pubmed, Web of Science, Cinahl, and PsycInfo through July 2013, plus hand-searching and author contact; 7,192 hits yielded 54 included papers, assessing 52 games in 61 evaluations.
  • Random-effects Hedges’ g was used, with mixed-effects moderator analyses, Cochran’s Q and I² for heterogeneity, meta-regression for continuous moderators, and sensitivity analyses for outliers, pre-test–post-test correlations, and publication bias.
  • Primary outcomes were behavior, knowledge, behavioral intentions, perceived barriers, skills, attitudes, subjective norm, and self-efficacy; clinical outcomes were secondary. Study quality was assessed with EPHPP; interrater reliability was ICC=0.90 for coding and ICC=0.98 for quality.

Limitations

  • Stated: “no evidence for an effect” does not equal “evidence for no effect”; some analyses were likely underpowered (e.g., mental health, social behavior, clinical outcomes). Other factors such as game features were not included and may explain heterogeneity. Publication bias is a concern, and analyses were limited by information available in manuscripts and from researchers. The review included various health behaviors that may be difficult to compare.
  • Evident from the text: heterogeneity was high for behavior and determinants; some moderator categories had fewer than 3 studies and were not analyzed (e.g., tailoring by socio-demographic information only); only one game for the elderly was included, and subjective norms were measured in only one study.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1016/j.ypmed.2014.08.026

Cites

130 of 130 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

0 of 36 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    At the second post-test, greater time elapsed until measurement was associated with smaller effect size for behavior.

    “This was, however, the opposite at second post-test: here the greater the time elapsed until post-test measurement, the smaller the effect size for behavior”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: The pre-test-post-test correlation is 0.50 for effect size calculation.
  • Findingown data

    Average effect sizes on behavior, its determinants, and clinical outcomes did not differ significantly by health domain.

    “There were no significant differences in average effect size on behavior nor on its determinants or clinical outcome by health domain.”
    • Also stated in: § Effectiveness of games in changing healthy lifestyles · plain
      “No significant heterogeneity was observed between games’ effects in different health domains.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: The pre-test-post-test correlation is 0.50 for effect size calculation.
  • Findingown data

    Serious digital games produce a small positive improvement in behavioral determinants (g=0.334, 95% CI 0.260 to 0.407).

    “and their determinants (g=0.334, 95% CI 0.260; 0.407), especially for knowledge.”
    • Also stated in: § Effectiveness of games in changing healthy lifestyles · plain
      “For behavioral determinants, average effect size was similarly small (g=0.334 (95% CI 0.260; 0.407), n=19934, k=50)”
    • Also stated in: § Discussion · plain
      “improved antecedents that determine adoption (g=0.334, 95% CI 0.260; 0.407)”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: The pre-test-post-test correlation is 0.50 for effect size calculation.
  • Findingown data

    The elapsed time between last game play and first post-test was a significant moderator for behavior: greater time was associated with larger effect size.

    “The elapsed time between the last time the game was played and when the outcome was measured, was a significant moderator in the games’ effects, but only for behavior. More specifically, the greater the amount of time between the last game play and first post-test for behavior, the larger the effect size (Table 8).”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: The pre-test-post-test correlation is 0.50 for effect size calculation.
  • Findingown data

    At the second post-test, the inverse relation between time and effect was also true for behavioral determinants.

    “This inverse relation between time and effect was also true for behavioral determinants (Table 8).”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: The pre-test-post-test correlation is 0.50 for effect size calculation.
  • May combine two claims. 24
  • Classified as probably not a substantial claim. 19

  • May combine two claims.

    Findingown data

    After trim-and-fill adjustment for publication bias, the average effect on behavioral determinants was reduced to g=0.179 (95% CI 0.104 to 0.254) but remained significant.

    “Using Duval’s and Tweedie’s Trim and Fill approach to impute missing studies to the left of the mean, adjusted average g for behavioral determinants was reduced to g=0.179 (95% CI 0.104; 0.254) but remained significant.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: The pre-test-post-test correlation is 0.50 for effect size calculation.

  • May combine two claims.

    Findingown data

    Among specific behavioral determinants, the largest effects were found for improvement in knowledge and attitudes, but all effect sizes were small.

    “Among specific behavioral determinants, the largest effects were found for improvement in knowledge and attitudes; however, all effect sizes were small.”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: The pre-test-post-test correlation is 0.50 for effect size calculation.

  • May combine two claims.

    Findingown data

    The type of theoretical foundation significantly affected effectiveness for behavioral determinants, but not for behavior or clinical outcomes.

    “The type of theoretical foundation significantly affected effectiveness for behavioral determinants, but not for behavior or clinical outcomes (Table 5–7).”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: The pre-test-post-test correlation is 0.50 for effect size calculation.

  • May combine two claims.

    Findingown data

    Neither average age of participants nor percentage of women in the sample was a significant moderator of game effectiveness on behavior, determinants, or clinical outcomes.

    “Neither the average age of participants nor the percentage of women in the sample was a significant moderator on game effectiveness on behavior, determinants or clinical outcomes (note: only one game for the elderly was included) (Table 8).”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: The pre-test-post-test correlation is 0.50 for effect size calculation.

  • May combine two claims.

    Findingown data

    Publication bias could not be ruled out for effects on behavioral determinants, with smaller published studies tending to report larger effects.

    “Funnel plot and Egger’s Test (t(48)=6.042, p<.001) indicated publication bias could not be ruled out for effects on behavioral determinants with a tendency for smaller published studies to report higher effect sizes.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: The pre-test-post-test correlation is 0.50 for effect size calculation.

  • May combine two claims.

    Findingown data

    Individual tailoring was a significant moderator of effects on behavioral determinants, but not of effects on behavior or clinical outcomes.

    “Individual tailoring was only a significant moderator for the effects on behavioral determinants, but not for behavior or clinical outcomes (Table 5–7).”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: The pre-test-post-test correlation is 0.50 for effect size calculation.

  • May combine two claims.

    Findingown data

    Both stand-alone and multi-component implementation had significant average effects for behavioral determinants and clinical outcomes; stand-alone games' effects on behavior showed only a trend to significance.

    “Both forms of implementation had significant average effect sizes for behavioral determinants and clinical outcomes. Average effects on behavior of stand-alone games however showed only a trend to significance.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: The pre-test-post-test correlation is 0.50 for effect size calculation.

  • May combine two claims.

    Findingown data

    Games based purely on behavioral prediction theories had the lowest average effect size, although their effects were still significant.

    “Games based purely on behavioral prediction theories had the lowest average effect size. Their effects were however still significant (Table 6).”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: The pre-test-post-test correlation is 0.50 for effect size calculation.

  • May combine two claims.

    Findingown data

    Study quality did not significantly affect effectiveness for behavior, determinants, or clinical outcomes.

    “The quality of the study did not significantly affect the effectiveness for behavior, determinants or clinical outcomes (Table 5–7).”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: The pre-test-post-test correlation is 0.50 for effect size calculation.

  • May combine two claims.

    Findingown data

    Egger's test for publication bias was not significant for effects on behavior or clinical outcomes.

    “For effects on behavior (t(19)=1.51, p=0.07) and on clinical outcomes (t(8)=0.762, p=0.233), Egger’s Test on publication bias was not significant.”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: The pre-test-post-test correlation is 0.50 for effect size calculation.

  • May combine two claims.

    Findingown data

    There was high heterogeneity between games' effects for behavior and behavioral determinants at both first post-test and follow-up, but not for clinical outcomes.

    “There was high heterogeneity between games’ effects for behavior and behavioral determinants, both at first post-test and at follow-up test, but not for clinical outcomes.”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: The pre-test-post-test correlation is 0.50 for effect size calculation.

  • May combine two claims.

    Findingown data

    At the second post-test, average effects on behavioral determinants and clinical outcomes were significant and similar in magnitude to the first post-test.

    “For behavioral determinants and clinical outcomes, average effect size at second post-test measurement was significant and of similar magnitude as at first post-measurement (Table 3).”
    • Also stated in: § Abstract · plain
      “Long-term effects were maintained for all outcomes except for behavior.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: The pre-test-post-test correlation is 0.50 for effect size calculation.

  • May combine two claims.

    Findingown data

    At the second post-test, the average effect on behavior was smaller than at the first post-test and did not reach statistical significance.

    “Average effect size for behavior at second post-test measurement was smaller than at first post-intervention measurement and failed to reach significance (p=.07).”
    • Also stated in: § Discussion · plain
      “Although effects at follow-up measurement were significant and positive for most outcomes, they were smaller than at the immediate post-measurement, and failed to reach significance for behavior.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: The pre-test-post-test correlation is 0.50 for effect size calculation.

  • May combine two claims.

    Findingown data

    At the second post-test, average effect size remained highest for knowledge and approximated a moderate effect size, but average effects were smaller for other behavioral determinants compared to first post-measurement.

    “At second post-test, average effect size remained highest for knowledge and approximated a moderate effect size, but average effects were smaller for other behavioral determinants compared to first post-measurement (with the exception of subjective norms, measured in only one study) (Table 4).”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: The pre-test-post-test correlation is 0.50 for effect size calculation.

  • Probably not a substantial claim: may not pass S4 (based).

    Findingnone given

    No meta-analysis of serious games for healthy lifestyle promotion had been reported prior to this study.

    “As yet, no meta-analysis of serious games for healthy lifestyle promotion has been reported.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingnone given

    In the included game studies, the theoretical foundation was often mentioned briefly, but how theoretical techniques were applied to target outcomes was not described.

    “Often game studies briefly mentioned which theoretical foundation was used, but not how theoretical techniques were applied to address the target outcome.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingnone given

    Serious games were effective either as a stand-alone or multi-component program.

    “They were effective either as a stand-alone or multi-component program”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    The relation between time and effect on behavior is curvilinear, with a minimal time needed to practice the behavior at first post-test but longer follow-up showing smaller effects.

    “suggesting a curvilinear relation, in which a minimal time is needed to practice the behavior at first post-test to have effects, but where a longer follow-up time showed smaller effects on behavior.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Self-efficacy has a strong association with behavior change.

    “as was the case for self-efficacy, which is another determinant with a strong association with behavior change (Bartholomew, Parcel, Kok, Gottlieb, & Fernàndez 2011).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Bartholomew, Parcel, Kok, Gottlieb, & Fernàndez 2011

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Games are thought to provide a good medium for increasing self-efficacy because they offer enactive experience in a safe environment without real-life consequences.

    “Games are thought to provide a good medium for increasing self-efficacy as they offer the opportunity for enactive experience in a safe environment, without real-life consequences to making wrong decisions (Peng 2008;Prensky 2007).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Peng 2008 source

      Not checked in the free run.

    • cites Prensky 2007

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationcitation

    Other game characteristics may influence game effectiveness and may be applied differently in stand-alone or multi-component games.

    “Many other game characteristics (e.g. use of a narrative, challenge in the game, co-design, scaffolding levels) (Kapp 2012;Lu, Baranowski, Thompson, & Buday 2012) may influence game effectiveness and may be applied differently in stand-alone or multi-component games.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Kapp 2012

      Not checked in the free run.

    • cites Lu, Baranowski, Thompson, & Buday 2012

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Other studies have reported that theory terminology is used inconsistently across interventions, with one term representing different techniques and different labels used for the same technique.

    “Other studies have indeed reported that the terminology of theories is not used in a consistent manner across interventions and that one term may be used to represent different techniques, as well as that different labels may be used for the same technique (Michie et al. 2011a).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Michie et al. 2011a

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    Interpretation and application of theories may have varied across the game studies.

    “Interpretation and application of theories may therefore have been different across game studies.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    It appeared insufficient to tailor games only to behavioral change needs; games are best tailored by both socio-demographic information and behavioral change needs.

    “It appeared insufficient to tailor games only to behavioral change needs, instead games are best tailored by both socio-demographic information (e.g. age, gender, body frame) and behavioral change needs (e.g. current level of lifestyle adoption, already acquired knowledge, stages of change, or motivation).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    One study's outcome exceeded the outlier threshold and was removed from analyses.

    “For one study (Jantz et al. 2002) the effect size of one outcome exceeded the outlier threshold; this outcome was hence removed from the analyses.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Jantz et al. 2002 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Use of self-regulation theories has been recommended to improve effectiveness of computer-tailored interventions.

    “For computer-tailored interventions, the use of self-regulation theories has been recommended to improve effectiveness (Lustria, Cortese, Noar, & Glueckauf 2009).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Lustria, Cortese, Noar, & Glueckauf 2009 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Methods used in non-game healthy lifestyle interventions to maintain long-term effect on behavior include reinforcement, booster sessions, tailored reminders, self-regulation, anticipatory coping, Motivational Interviewing, and multi-level environmental changes.

    “Methods used in non-game healthy lifestyle interventions to maintain a long-term effect on behavior were providing reinforcement throughout follow-up, having booster sessions, sending tailored reminders, using self-regulation and anticipatory coping techniques to deal with potential relapse, integrating Motivational Interviewing techniques and creating healthy-behavior-facilitating changes in the”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Jacobs et al. 2004 source

      Not checked in the free run.

    • cites Lustria, Cortese, Noar, & Glueckauf 2009 source

      Not checked in the free run.

    • cites Martins and McNeil 2009

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    For games, dynamic tailoring has been recommended based on difficulty level to ensure flow and optimal challenge.

    “For games, dynamic tailoring has been recommended based on the difficulty level the player can master (e.g. via providing hints when the challenge is too hard), to ensure flow and to provide all players with an optimal level of challenge (Charles et al. 2005;Wilson et al. 2009).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Charles et al. 2005

      Not checked in the free run.

    • cites Wilson et al. 2009 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Leisure games are played 7 hours per week on average.

    “while leisure games are played 7 hours per week on average (Boyle, Connolly, Hainey, & Boyle 2012).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Boyle, Connolly, Hainey, & Boyle 2012

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductown data

    The current meta-analysis coded intervention duration and time until measurement separately.

    “These were coded separately in our meta-analyses, singling out effect of intervention duration versus duration until measurement.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Primack et al. reported that interventions lasting fewer than 12 weeks more often achieved their objectives than longer interventions.

    “They reported that interventions lasting fewer than 12 weeks more often achieved their objectives than interventions lasting longer.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Primack, Carroll, McNamara, Klem, King, Rich, Chan, & Nayak 2012

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Decreasing risky behavior may be harder to achieve than increasing health-promoting behavior.

    “Decreasing risky behavior may be harder to achieve than increasing health-promoting behavior (Adriaanse et al. 2011).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Adriaanse et al. 2011 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The meta-analysis did not distinguish between reducing unhealthy behavior and increasing healthy actions.

    “Our meta-analysis did not distinguish between reducing unhealthy behavior or increasing healthy actions.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Game features were not included as moderators in the meta-analysis.

    “These features were not included here.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    The review included various types of health behaviors, which may be difficult to compare.

    “Lastly, this review included various types of health behaviors, which may be difficult to compare.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Study design and conductnone given

    Publication bias is a concern, and reported effect sizes may be overestimated (e.g., for behavioral determinants).

    “Third, publication bias is always a concern: reported effect sizes may be overestimated (e.g. behavioral determinants).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The analyses were limited by the information available in the manuscripts and obtained from researchers.

    “The analyses were furthermore limited by the information available in the manuscripts and that additionally obtained from the researchers.”
    Quote in the paperNot a substantial claim
37 of 37

  • The authors state this as an assumption.

    The pre-test-post-test correlation is 0.50 for effect size calculation.

    “pre-test-post-test correlations set lower (0.20) and higher (0.80) than the standard assumption of 0.50”

  • The paper relies on this without support.

    The theoretical foundation categories coded from the primary studies accurately represent the theories actually used in those games.

    “Often game studies briefly mentioned which theoretical foundation was used, but not how theoretical techniques were applied to address the target outcome.”
2 of 2

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • The most comparable serious games for health meta-analysis (DeSmet et al., 2014) found 53 studies published between 1989 and 2013 (average 2 studies/year).

    “The most comparable serious games for health meta-analysis in terms of inclusion and exclusion criteria is DeSmet et al. (2014), which found 53 studies published between 1989 and 2013 (avg. 2 studies/year).”

    From Gamification for health and wellbeing: A systematic review of the literature (2016) · cites this paper as DeSmet et al. (2014)

    The Results report 54 included papers, not the claimed 53. The Methods say the search ran through July 2013, and the References include a 1989 study, but the cited passages do not establish the claimed publication range or state an average of two studies per year. Page numbers are unavailable in our copy. (LLM, conf=0.89)

    Experimental — accuracy not yet measured

  • Several controlled trials of serious games have shown effects on real-world behaviors in diverse patient groups.

    “Although the scientific evaluation of serious games precludes making conclusive statements about their impact on “real-world” behaviors, several controlled trials of serious games have shown to affect these behaviors in diverse patient groups [42].”

    From Behavioral Outcome Effects of Serious Gaming as an Adjunct to Treatment for Children with Attention-Deficit/Hyperactivity Disorder: A Randomized Controlled Trial (2016) · cites this paper as [42]

  • A zeitgeist has emerged in the medical and educational fields for applied or serious games as tools for enhancing medical care.

    “A zeitgeist has emerged in the medical and educational fields for applied or “serious” games as tools for enhancing medical care [58-61].”

    From Use of the Principles of Design Thinking to Address Limitations of Digital Mental Health Interventions for Youth: Viewpoint (2019) · cites this paper as [59]

Statistics recomputed

Every reported test result, recomputed from its test statistic and degrees of freedom. A result shows as not adding up only once an independent check has confirmed it.

  • Not confirmedt(19) = 1.51reported p = .07 · recomputed p = .147

    “t(19)=1.51, p = .07”

  • Not confirmedt(8) = 0.762reported p = .233 · recomputed p = .468

    “t(8)=0.762, p = .233”

  • Consistentt(48) = 6.042reported p < .001 · recomputed p < .001

    “t(48)=6.042, p < .001”

3 of 3

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Clinical-outcome confidence interval has two lower bounds

    Minor

    The abstract gives the lower bound of the first-post-test clinical-outcome confidence interval as 0.038, while the Results give it as 0.039 for the same effect estimate.

1 of 1

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Related

Authors
DeSmet, A., Van Ryckeghem, D., Compernolle, S., Baranowski, T., Thompson, D., Crombez, G., Poels, K., Van Lippevelde, W., Bastiaensens, S., Van Cleemput, K., Vandebosch, H., & De Bourdeaudhuij, I.
Affiliations
  • Ghent University (BE)
  • Baylor College of Medicine (US)
  • University of Antwerp (BE)
Corresponding author
DeSmet, Ann
ORCID
Venue
Preventive Medicine
Publisher
Elsevier BV
Published
2014-12
Volume
69
Pages
95-107
ISSN
0091-7435 (ISSN-L)
DOI
10.1016/j.ypmed.2014.08.026
PMC
PMC4403732
OpenAlex
W2093118219
Semantic Scholar
228e274dce3a3661790bf4291e9d5fe1681c2aca
Cited by
414
References
143
Citations by year
2026: 20 · 2025: 26 · 2024: 50 · 2023: 34 · 2022: 31 · 2021: 51 · 2020: 38 · 2019: 30 · 2018: 50 · 2017: 28 · 2016: 33 · 2015: 16 · 2014: 5 · 2013: 1
FWCI
5.28
Type
journal article
Language
en
Open access
Licence
Locations
  • Preventive Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • Research Publications (Maastricht University) (publishedVersion, other-oa)
  • PubMed Central (acceptedVersion)
  • Ghent University Academic Bibliography (Ghent University) (submittedVersion)
  • Dépôt institutionnel de l'Université libre de Bruxelles (Université Libre de Bruxelles) (submittedVersion, other-oa)
  • Open Repository and Bibliography (University of Luxembourg) (submittedVersion, cc-by-nc-sa)
  • Research Publications (Maastricht University) (submittedVersion)
Funders
Danish Agency for Science and Higher Education
Topics
  • Social Sciences › Psychology › Developmental and Educational Psychology › Educational Games and Gamification
  • Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
  • Social Sciences › Arts and Humanities › Literature and Literary Theory › Media Influence and Health
Keywords
serious games, video games, healthy lifestyle promotion, health behavior change, game theory, knowledge outcomes, long-term effects, sociodemographic moderators, multicomponent intervention, game features
MeSH terms
Female, Health Promotion, Humans, Life Style, Male, Recreation, Health Behavior, Video Games

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-08.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-08.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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