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A meta-analysis of serious digital games for healthy lifestyle promotion
Open accessAbstract
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.
Overview
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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.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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”
§ A Meta-Analysis of Serious Digital Games for Healthy Lifestyle Promotion > Results > Influence of study, sample and game characteristics as moderators of game effectiveness
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes- The authors state this as an assumption: The pre-test-post-test correlation is 0.50 for effect size calculation.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ A Meta-Analysis of Serious Digital Games for Healthy Lifestyle Promotion > Results > Effectiveness of games in changing healthy lifestyles
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- The authors state this as an assumption: The pre-test-post-test correlation is 0.50 for effect size calculation.
- Also stated in: § Effectiveness of games in changing healthy lifestyles · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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)”
§ A Meta-Analysis of Serious Digital Games for Healthy Lifestyle Promotion > Abstract
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- The authors state this as an assumption: The pre-test-post-test correlation is 0.50 for effect size calculation.
- Also stated in: § Effectiveness of games in changing healthy lifestyles · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ A Meta-Analysis of Serious Digital Games for Healthy Lifestyle Promotion > Results > Influence of study, sample and game characteristics as moderators of game effectiveness
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes- The authors state this as an assumption: The pre-test-post-test correlation is 0.50 for effect size calculation.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“This inverse relation between time and effect was also true for behavioral determinants (Table 8).”
§ A Meta-Analysis of Serious Digital Games for Healthy Lifestyle Promotion > Results > Influence of study, sample and game characteristics as moderators of game effectiveness
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes- The authors state this as an assumption: The pre-test-post-test correlation is 0.50 for effect size calculation.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“None of the other study characteristics were significant moderators in the average effects on behavior, determinants or clinical outcomes.”
§ A Meta-Analysis of Serious Digital Games for Healthy Lifestyle Promotion > Results > Influence of study, sample and game characteristics as moderators of game effectiveness
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes- The authors state this as an assumption: The pre-test-post-test correlation is 0.50 for effect size calculation.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“For behavioral determinants, games tailored only by change needs or stages of adoption had a lower effect size than games which were not tailored or tailored to both socio-demographics and change needs.”
§ A Meta-Analysis of Serious Digital Games for Healthy Lifestyle Promotion > Results > Influence of study, sample and game characteristics as moderators of game effectiveness
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- The authors state this as an assumption: The pre-test-post-test correlation is 0.50 for effect size calculation.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Implementation method was not a significant moderator of game effectiveness for either behavior, determinants or clinical outcomes (Table 5–7).”
§ A Meta-Analysis of Serious Digital Games for Healthy Lifestyle Promotion > Results > Influence of study, sample and game characteristics as moderators of game effectiveness
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes- The authors state this as an assumption: The pre-test-post-test correlation is 0.50 for effect size calculation.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“For behavior, games evaluated in a post-test only control groups design had a lower average effect size (borderline significant) than games evaluated in other study designs (Table 5).”
§ A Meta-Analysis of Serious Digital Games for Healthy Lifestyle Promotion > Results > Influence of study, sample and game characteristics as moderators of game effectiveness
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes- The authors state this as an assumption: The pre-test-post-test correlation is 0.50 for effect size calculation.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In our review, effects on self-efficacy were unexpectedly small.”
§ A Meta-Analysis of Serious Digital Games for Healthy Lifestyle Promotion > Discussion
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes
- It may state two separate claims as one. 24
- Probably not a substantial claim. 19
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In the paper
“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.”
§ A Meta-Analysis of Serious Digital Games for Healthy Lifestyle Promotion > Results > Effectiveness of games in changing healthy lifestyles
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- The authors state this as an assumption: The pre-test-post-test correlation is 0.50 for effect size calculation.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Among specific behavioral determinants, the largest effects were found for improvement in knowledge and attitudes; however, all effect sizes were small.”
§ A Meta-Analysis of Serious Digital Games for Healthy Lifestyle Promotion > Results > Influence of study, sample and game characteristics as moderators of game effectiveness
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
- The authors state this as an assumption: The pre-test-post-test correlation is 0.50 for effect size calculation.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The type of theoretical foundation significantly affected effectiveness for behavioral determinants, but not for behavior or clinical outcomes (Table 5–7).”
§ A Meta-Analysis of Serious Digital Games for Healthy Lifestyle Promotion > Results > Influence of study, sample and game characteristics as moderators of game effectiveness
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- The authors state this as an assumption: The pre-test-post-test correlation is 0.50 for effect size calculation.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ A Meta-Analysis of Serious Digital Games for Healthy Lifestyle Promotion > Results > Influence of study, sample and game characteristics as moderators of game effectiveness
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
- The authors state this as an assumption: The pre-test-post-test correlation is 0.50 for effect size calculation.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ A Meta-Analysis of Serious Digital Games for Healthy Lifestyle Promotion > Results > Effectiveness of games in changing healthy lifestyles
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- The authors state this as an assumption: The pre-test-post-test correlation is 0.50 for effect size calculation.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Individual tailoring was only a significant moderator for the effects on behavioral determinants, but not for behavior or clinical outcomes (Table 5–7).”
§ A Meta-Analysis of Serious Digital Games for Healthy Lifestyle Promotion > Results > Influence of study, sample and game characteristics as moderators of game effectiveness
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- The authors state this as an assumption: The pre-test-post-test correlation is 0.50 for effect size calculation.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ A Meta-Analysis of Serious Digital Games for Healthy Lifestyle Promotion > Results > Influence of study, sample and game characteristics as moderators of game effectiveness
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- The authors state this as an assumption: The pre-test-post-test correlation is 0.50 for effect size calculation.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Games based purely on behavioral prediction theories had the lowest average effect size. Their effects were however still significant (Table 6).”
§ A Meta-Analysis of Serious Digital Games for Healthy Lifestyle Promotion > Results > Influence of study, sample and game characteristics as moderators of game effectiveness
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
- The authors state this as an assumption: The pre-test-post-test correlation is 0.50 for effect size calculation.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The quality of the study did not significantly affect the effectiveness for behavior, determinants or clinical outcomes (Table 5–7).”
§ A Meta-Analysis of Serious Digital Games for Healthy Lifestyle Promotion > Results > Influence of study, sample and game characteristics as moderators of game effectiveness
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
- The authors state this as an assumption: The pre-test-post-test correlation is 0.50 for effect size calculation.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ A Meta-Analysis of Serious Digital Games for Healthy Lifestyle Promotion > Results > Effectiveness of games in changing healthy lifestyles
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
- The authors state this as an assumption: The pre-test-post-test correlation is 0.50 for effect size calculation.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ A Meta-Analysis of Serious Digital Games for Healthy Lifestyle Promotion > Results > Effectiveness of games in changing healthy lifestyles
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
- The authors state this as an assumption: The pre-test-post-test correlation is 0.50 for effect size calculation.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ A Meta-Analysis of Serious Digital Games for Healthy Lifestyle Promotion > Results > Effectiveness of games in changing healthy lifestyles
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- The authors state this as an assumption: The pre-test-post-test correlation is 0.50 for effect size calculation.
- Also stated in: § Abstract · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ A Meta-Analysis of Serious Digital Games for Healthy Lifestyle Promotion > Results > Effectiveness of games in changing healthy lifestyles
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- The authors state this as an assumption: The pre-test-post-test correlation is 0.50 for effect size calculation.
- Also stated in: § Discussion · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ A Meta-Analysis of Serious Digital Games for Healthy Lifestyle Promotion > Results > Influence of study, sample and game characteristics as moderators of game effectiveness
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
- The authors state this as an assumption: The pre-test-post-test correlation is 0.50 for effect size calculation.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“As yet, no meta-analysis of serious games for healthy lifestyle promotion has been reported.”
§ A Meta-Analysis of Serious Digital Games for Healthy Lifestyle Promotion > Introduction
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✗ Based: failsProbably not a substantial claim. The paper may give no reason why it holds.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Often game studies briefly mentioned which theoretical foundation was used, but not how theoretical techniques were applied to address the target outcome.”
§ A Meta-Analysis of Serious Digital Games for Healthy Lifestyle Promotion > Discussion
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“They were effective either as a stand-alone or multi-component program”
§ A Meta-Analysis of Serious Digital Games for Healthy Lifestyle Promotion > Conclusions
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ A Meta-Analysis of Serious Digital Games for Healthy Lifestyle Promotion > Results > Influence of study, sample and game characteristics as moderators of game effectiveness
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“as was the case for self-efficacy, which is another determinant with a strong association with behavior change (Bartholomew, Parcel, Kok, Gottlieb, & Fernàndez 2011).”
§ A Meta-Analysis of Serious Digital Games for Healthy Lifestyle Promotion > Discussion
What the sources say
- Not checked yetcites Bartholomew, Parcel, Kok, Gottlieb, & Fernàndez 2011
Strength:boosted· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“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).”
§ A Meta-Analysis of Serious Digital Games for Healthy Lifestyle Promotion > Discussion
What the sources say
- Not checked yetcites Peng 2008 source
- Not checked yetcites Prensky 2007
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“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.”
§ A Meta-Analysis of Serious Digital Games for Healthy Lifestyle Promotion > Discussion
What the sources say
- Not checked yetcites Kapp 2012
- Not checked yetcites Lu, Baranowski, Thompson, & Buday 2012
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“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).”
§ A Meta-Analysis of Serious Digital Games for Healthy Lifestyle Promotion > Discussion
What the sources say
- Not checked yetcites Michie et al. 2011a
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Interpretation and application of theories may therefore have been different across game studies.”
§ A Meta-Analysis of Serious Digital Games for Healthy Lifestyle Promotion > Discussion
Strength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ A Meta-Analysis of Serious Digital Games for Healthy Lifestyle Promotion > Discussion
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“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.”
§ A Meta-Analysis of Serious Digital Games for Healthy Lifestyle Promotion > Results > Effectiveness of games in changing healthy lifestyles
What the sources say
- Not checked yetcites Jantz et al. 2002 source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“For computer-tailored interventions, the use of self-regulation theories has been recommended to improve effectiveness (Lustria, Cortese, Noar, & Glueckauf 2009).”
§ A Meta-Analysis of Serious Digital Games for Healthy Lifestyle Promotion > Discussion
What the sources say
- Not checked yetcites Lustria, Cortese, Noar, & Glueckauf 2009 source
Strength:plain· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“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”
§ A Meta-Analysis of Serious Digital Games for Healthy Lifestyle Promotion > Discussion
What the sources say
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“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).”
§ A Meta-Analysis of Serious Digital Games for Healthy Lifestyle Promotion > Discussion
What the sources say
- Not checked yetcites Charles et al. 2005
- Not checked yetcites Wilson et al. 2009 source
Strength:plain· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“while leisure games are played 7 hours per week on average (Boyle, Connolly, Hainey, & Boyle 2012).”
§ A Meta-Analysis of Serious Digital Games for Healthy Lifestyle Promotion > Discussion
What the sources say
- Not checked yetcites Boyle, Connolly, Hainey, & Boyle 2012
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“These were coded separately in our meta-analyses, singling out effect of intervention duration versus duration until measurement.”
§ A Meta-Analysis of Serious Digital Games for Healthy Lifestyle Promotion > Discussion
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
In the paper
“They reported that interventions lasting fewer than 12 weeks more often achieved their objectives than interventions lasting longer.”
§ A Meta-Analysis of Serious Digital Games for Healthy Lifestyle Promotion > Discussion
What the sources say
- Not checked yetcites Primack, Carroll, McNamara, Klem, King, Rich, Chan, & Nayak 2012
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“Decreasing risky behavior may be harder to achieve than increasing health-promoting behavior (Adriaanse et al. 2011).”
§ A Meta-Analysis of Serious Digital Games for Healthy Lifestyle Promotion > Limitations
What the sources say
- Not checked yetcites Adriaanse et al. 2011 source
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Our meta-analysis did not distinguish between reducing unhealthy behavior or increasing healthy actions.”
§ A Meta-Analysis of Serious Digital Games for Healthy Lifestyle Promotion > Limitations
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“These features were not included here.”
§ A Meta-Analysis of Serious Digital Games for Healthy Lifestyle Promotion > Limitations
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Lastly, this review included various types of health behaviors, which may be difficult to compare.”
§ A Meta-Analysis of Serious Digital Games for Healthy Lifestyle Promotion > Limitations
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Third, publication bias is always a concern: reported effect sizes may be overestimated (e.g. behavioral determinants).”
§ A Meta-Analysis of Serious Digital Games for Healthy Lifestyle Promotion > Limitations
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✗ Based: failsProbably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The analyses were furthermore limited by the information available in the manuscripts and that additionally obtained from the researchers.”
§ A Meta-Analysis of Serious Digital Games for Healthy Lifestyle Promotion > Limitations
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
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.”
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 source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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)
Experimental — accuracy not yet measuredIn the citing paper
“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].”
In the citing paper
“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”
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
MinorThe 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.
“Effects on clinical outcomes were significant, but much smaller (g=0.079, 95% CI 0.038; 0.120).”
“the average effect size on clinical outcomes was very small, but significant (g=0.079 (95% CI 0.039; 0.120), n=9367, k=10)”
Citations
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“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).”
BackgroundMethodBorenstein, M., Hedges, L. V., Higgins, J. P. T., & Rothstein, H. R. (2021) · doi:10.1002/9781119558378 · Cited by 9,799
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Distribution Theory for Glass's Estimator of Effect Size and Related Estimators
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“Random-effects Hedges' g was applied to indicate effect size, correcting for small sample sizes (Hedges, 1981).”
MethodLopez, A. D., Mathers, C. D., Ezzati, M., Jamison, D. T., & Murray, C. J. (2006) · The Lancet · doi:10.1016/s0140-6736(06)68770-9 · Cited by 5,630 · cited 1×
“…lifestyles comprise an array of potentially modifiable behaviors that can prevent a wide range of diseases, such as some cancers, cardiovascular diseases, stroke, dementia, mental illness, and diabetes (Fratiglioni et al., 2004; Kim et al., 2012; Lopez et al., 2006; Peel et al., 2005).”
BackgroundKapp, K. M. (2012) · Cited by 3,753
How should meta‐regression analyses be undertaken and interpreted?
Thompson, S. G., & Higgins, J. P. T. (2002) · Statistics in Medicine · doi:10.1002/sim.1187 · Cited by 3,026 · cited 1×
“Meta-regression (methods-of-moments procedure) was performed for continuous moderators (Thompson and Higgins, 2002), where the slope ( β ) and its p-value indicated the importance of this moderator in understanding linear changes in effect sizes.”
Method
Flagged first, then by citations
13 of the 143 references couldn’t be matched to a known paper.
Cited by
Sorted by citations
Items 101–200 of 428
The doctor’s digital double: how warmth, competence, and animation promote adherence intention
Dai, Z., & MacDorman, K. F. (2018) · PeerJ Computer Science · doi:10.7717/peerj-cs.168 · Cited by 30
Ossenbrink, L., Haase, T., Timpel, P., Schoffer, O., Scheibe, M., Schmitt, J., Deckert, S., & Harst, L. (2023) · JMIR Serious Games · doi:10.2196/44132 · Cited by 27
“The results confirm those of a meta-analysis by DeSmet et al [82], who showed significant positive effects of serious games on health behavior independent of any diagnosis and its theory-based determinants and significant but much smaller effects on various clinical outcomes.”
ResultFaith in Frames: Constructing a Digital Game‐Based Learning Framework for Religious Education
Papakostas, C. (2024) · Teaching Theology & Religion · doi:10.1111/teth.12685 · Cited by 56
Abraham, O., Thakur, T., & Brown, R. (2020) · JMIR Serious Games · doi:10.2196/18207 · Cited by 27
“Serious games that adopted theory in their design used small sample sizes for testing efficacy and effectiveness; hence, positive outcomes were demonstrated by only a few of these studies [30,34].”
Design Features in Games for Health
Kelley, C., Wilcox, L. G., Ng, W., Schiffer, J., & Hammer, J. (2017) · Designing Interactive Systems Conference · doi:10.1145/3064663.3064721 · Cited by 25
Fjællingsdal, K. S., & Klöckner, C. A. (2017) · Frontiers in Psychology · doi:10.3389/fpsyg.2017.01085 · Cited by 30
“Meta-analyses on the effects of educational gaming tend to reveal mixed to positive findings (e.g., Vogel et al., 2006; Ke, 2009; DeSmet et al., 2014), suggesting that implementing educational games requires a careful consideration of contextual variables.”
BackgroundHaruna, H., Hu, X., & Chu, S. K. W. (2018) · Global Journal of Health Science · doi:10.5539/gjhs.v10n3p172 · Cited by 26
Villegas-Navas, V., Simó, M. J. M., & Padilla, R. A. A. (2020) · Nutrients · doi:10.3390/nu12040964 · Cited by 32
“As far as we know, those reviews have focused on whether some specific entertainment formats, such as videogames [17] and advergames [18,19], and whether marketing products in general (food embedded with a clear persuasive intention) [20,21], are impactful tools to modify the eating behaviors of children.”
BackgroundJander, A., Crutzen, R., Mercken, L. A. G., & de Vries, H. (2015) · BMC Public Health · doi:10.1186/s12889-015-1639-z · Cited by 24
“The results concerning knowledge acquisition and attitude and behavior change are promising [67,68].”
BackgroundA game for emotional regulation in adolescents: The (body) interface device matters
Vara, M. D., Baños, R., Rasal, P., Rodríguez, A., Solaz, B. R., Wrzesien, M., & Alcañíz, M. (2015) · Computers in Human Behavior · doi:10.1016/j.chb.2015.12.033 · Cited by 31
An investigation on using serious gaming to study human decision-making in engineering contexts
Vermillion, S. D., Malak, R., Smallman, R., Becker, B., Sferra, M. S., & Fields, S. A. (2017) · Design Science · doi:10.1017/dsj.2017.14 · Cited by 28
Hemingway, C., Baja, E. S., Dalmacion, G. V., Medina, P. M. B., Guevara, E. G., Sy, T. R., Dacombe, R. J., Dormann, C., & Taegtmeyer, M. (2019) · JMIR Serious Games · doi:10.2196/13695 · Cited by 21
“A recent meta-analysis of 54 digital games for healthy lifestyle promotion found small but significant effects on behavior, determinants, and clinical outcomes, demonstrating the potential benefits [15].”
BackgroundFeasibility and Acceptability of ‘VitaVillage’: A Serious Game for Nutrition Education
de Vlieger, N., Sainsbury, L., Smith, S. P., Riley, N., Miller, A., Collins, C. E., & Bucher, T. (2021) · Nutrients · doi:10.3390/nu14010189 · Cited by 24
“on serious digital games for healthy lifestyle promotion noted that players seem to be more willing to learn through games, compared to traditional teaching methods, as long as the game’s challenge was feasible [31].”
BackgroundGames for active ageing, well-being and quality of life: a pilot study
Costa, L. V., Veloso, A. I., Loizou, M., & Arnab, S. (2018) · Behaviour and Information Technology · doi:10.1080/0144929x.2018.1485744 · Cited by 21
“Other studies (Baranowski et al. 2008; Hall et al. 2012; DeSmet et al. 2014) have also revealed the potential benefits of games for mental well-being and behaviours.”
BackgroundDernat, S., Rigolot, C., Vollet, D., Cayré, P., & Dumont, B. (2021) · The Journal of Agricultural Education and Extension · doi:10.1080/1389224x.2021.1873155 · Cited by 22
Gamification and Behavioral Change
Bamidis, P. D., Gabarrón, E., Hors-Fraile, S., Konstantinidis, E. I., Konstantinidis, S. T., & Rivera, O. (2016) · Elsevier eBooks · doi:10.1016/b978-0-12-809269-9.00007-4 · Cited by 21
Vugts, M. A. P., Zedlitz, A. M. E. E., Joosen, M. C. W., & Vrijhoef, H. J. (2019) · Journal of Medical Internet Research · doi:10.2196/14766 · Cited by 21
“Plausibly, serious games and other computer applications for CP or FSS patients reach stronger, average effects when delivered as stand-alone interventions in other circumstances (eg, when compared with no active treatment) [1,30].”
InfluentialFrom exergames to immersive virtual reality systems: serious games for supporting older adults
Muñoz, J. E., Montoya, M. F., & Boger, J. N. (2021) · Elsevier eBooks · doi:10.1016/b978-0-323-85173-2.00011-4 · Cited by 25
Conde-Pumpido, T. D. L. H., Jansz, J., Raessens, J., & Schouten, B. (. (2021) · Amsterdam University Press eBooks · doi:10.2307/j.ctv1hw3z1d · Cited by 24
Guala, M. M., Bul, K., Skårderud, F., & Nielsen, A. S. (2022) · JMIR Formative Research · doi:10.2196/40594 · Cited by 17
“SGs have gained acknowledgment in the fields of health and mental health treatment [20-24], probably because of factors such as play, which is inherently fun.”
BackgroundGamification in eHealth for Chronic Disease Self-Management in Youth: A Systematic Review
Stutvoet, M. D., Levelt, L., Hrehovcsik, M. M., Veer, J. V., Visch, V., Bramer, W. M., Hillegers, M. H. J., Veltkamp, R. C., Nijhof, S. L., & Estévez‐López, F. (2024) · Games for Health Journal · doi:10.1089/g4h.2023.0111 · Cited by 26
Beun, R. J., Luiten, C., Verbeek, C., & Poelman, M. P. (2021) · Frontiers in Digital Health · doi:10.3389/fdgth.2020.564529 · Cited by 22
The effects of a gamified approach avoidance training and verbal suggestions on food outcomes
Schakel, L., Veldhuijzen, D. S., van Middendorp, H., Dessel, P. V., Houwer, J. D., Rafael Bidarra, E., & Evers, A. W. M. (2018) · PLoS ONE · doi:10.1371/journal.pone.0201309 · Cited by 20
“This innovative tool is increasingly applied in healthcare practice [12, 13], and recent studies in the food-related health domain have provided preliminary evidence for its effectiveness in optimizing foodrelated outcomes, including food intake [14–16].”
BackgroundMethodHorsham, C., Dutton‐Regester, K., Antrobus, J., Goldston, A., Price, H., Ford, H., & Hacker, E. (2021) · JMIR Serious Games · doi:10.2196/24652 · Cited by 21
“VR has also been assessed for modifying health behaviors, such as smoking, diet, physical exercise, and compliance to prescribed treatment regimens [10-13].”
Gonçalves, A., Muñoz, J. E., Cameirão, M. S., Gouveia, É. R., Sousa, H., & Badia, S. B. I. (2021) · Games for Health Journal · doi:10.1089/g4h.2020.0092 · Cited by 20
“10 In terms of motivation and preferences, mastery over the game is an essential factor, 24 and a clear preference for gesture-based controllers was identified in the elderly.”
Serious Games for the Treatment of Children with ADHD: The BRAVO Project
Luca, V. D., Schena, A., Covino, A., Bitonto, P. D., Potenza, A., Barba, M. C., D’Errico, G., & Paolis, L. T. D. (2024) · Information Systems Frontiers · doi:10.1007/s10796-023-10457-8 · Cited by 24
“It is therefore more than appropriate to work on video games that are able to have a real impact on the lives of children with ADHD (DeSmet et al., 2014).”
Anderson, T. J., Prue, G., McDowell, G., et al. (2024) · BMC Public Health · doi:10.1186/s12889-024-18050-7 · Cited by 20
“Although the age range may suggest the younger population are more likely to engage with serious gaming, previous research has found serious games to be appealing to a diverse population regardless of age [37].”
BackgroundTechnology-based intervention for healthy lifestyle promotion in Italian adolescents.
Fraticelli, F., Marchetti, D., Polcini, F., et al. (2016) · PubMed · doi:10.4415/ann_16_01_20 · Cited by 20
“Since video gaming is a common pastime among adolescents, serious video games offer promise of innovative channels for effective healthy lifestyle promotion programs [1], and youth are the ideal target population for the prevention of metabolic diseases.”
BackgroundDeSmet, A., Liu, Y., Bourdeaudhuij, I. D., Baranowski, T., & Thompson, D. I. (2017) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/s12966-017-0506-y · Cited by 22
“Although a longer intervention duration may yield higher effects, the intervention period was longer than commonly the case in serious game interventions [37].”
BackgroundSelf-citationde Medeiros, C. S. P., Farias, L. B. A., Santana, M. C. D. L., Pacheco, T. B. F., Dantas, R. R., & Cavalcanti, F. A. D. C. (2024) · PLoS ONE · doi:10.1371/journal.pone.0306816 · Cited by 19
Conde-Pumpido, T. D. L. H., Jansz, J., Raessens, J., & Schouten, B. A. M. (2021) · Routledge eBooks · doi:10.5117/9789463728805 · Cited by 20
Incorporating Behavioral Techniques into a Serious Videogame for Children
Thompson, D. I. (2017) · Games for Health Journal · doi:10.1089/g4h.2016.0066 · Cited by 19
“Serious videogames, that is, engaging videogames that balance entertainment with behavior change,(9,10) are emerging as a potentially important behavior change method.(11,12) Although there is some evidence about how to design serious videogames to promote dietary behavior change, it remains a challenge.”
Self-citationRuggiero, L., Seltzer, E. D., Dufelmeier, D., Montoya, A. M., & Chebli, P. (2020) · Games for Health Journal · doi:10.1089/g4h.2019.0056 · Cited by 19
Promoting Occupational Health through Gamification and E-Coaching: A 5-Month User Engagement Study
Zhang, C., Gorp, P. M. E. V., Derksen, M., Nuijten, R., IJsselsteijn, W. A., Zanutto, A., Melillo, F., & Pratola, R. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18062823 · Cited by 22
“[45] supports this claim by recognizing that personalized interventions are more effective than their non-tailored counterparts.”
BackgroundSpook, J. E., Paulussen, T. G., Paulissen, R. T., Visschedijk, G. C., Kok, G., & van Empelen, P. (2015) · Games for Health Journal · doi:10.1089/g4h.2014.0142 · Cited by 19
“12 In order to circumvent these problems, our aim was to integrate behavior change methods into serious game design during the systematic development of a serious self-regulation game intervention.”
Gonçalves, A., Muñoz, J. E., Gouveia, É. R., Cameirão, M. S., & Badia, S. B. I. (2019) · The Visual Computer · doi:10.1007/s00371-019-01736-0 · Cited by 18
“Exergames can be as effective or more than conventional exercise [2] with small but significant clinical effects outcomes [3], several studies reporting particular improvements in gait, balance, and cognitive function [4, 5].”
BackgroundCraig, S. G., Barry, H. E., Carter, G., Stark, P., Mitchell, G., Clarke, S., & Wilson, C. B. (2024) · BMC Medical Education · doi:10.1186/s12909-024-05656-z · Cited by 21
“A recent systematic review and meta-analysis [14] suggests that digital games can be equally beneficial as a stand-alone or multi-component programme while appealing to a wide population regardless of age or gender.”
BackgroundGamification in knowledge management systems
Ďuriník, M. (2015) · Central European Journal of Management · doi:10.5817/cejm2014-2-3 · Cited by 17
“A serious game, on the other hand, has all the requirements of being a game – it is a full game with all the game aspects, even though it fulfills non-entertainment goals while being fun (DeSmet et al., 2014).”
BackgroundPersonalization in Game Design for Healthcare: a Literature Review on its Definitions and Effects
van Dooren, M. M. M., Visch, V., Spijkerman, R., Goossens, R., & Hendriks, V. M. (2016) · International Journal of Serious Games · doi:10.17083/ijsg.v3i4.134 · Cited by 14
“This is already present in our PDP, by involving stakeholders that know about theories of games and behavior change (domain experts and designers) in the whole PDP [113].”
BackgroundVieira‐Marques, P., Almeida, R., Teixeira, J. F., Valente, J., Jácome, C. I. O., Cachim, A., Guedes, R., Pereira, A. M., Jacinto, T., & Fonseca, J. (2021) · Methods of Information in Medicine · doi:10.1055/s-0041-1726277 · Cited by 16
NutritionRush - a serious game to support people with the awareness of their nutrition intake
Baranyi, R., Steyrer, B., Lechner, L., Agbektas, G. N., Lederer, N., & Grechenig, T. (2017) · SeGAH ... IEEE ... International Conference on Serious Games and Applications for Health/IEEE International Conference on Serious Games and Applications for Health · doi:10.1109/segah.2017.7939271 · Cited by 16
Games for health research—past, present, and future
Baranowski, T. (2018) · Prävention und Gesundheitsförderung · doi:10.1007/s11553-018-0657-y · Cited by 16
“G4H have had positive impacts on a diverse variety of health outcomes [18].”
BackgroundSelf-citationKok, D. K., Bisschops, I., Knoop, L., Tulu, L., Kujawa-Roeleveld, K., Masresha, N., & Houtkamp, J. M. (2020) · Environmental Science & Policy · doi:10.1016/j.envsci.2020.05.016 · Cited by 15
Shegog, R., Armistead, L., Markham, C. M., Dube, S., Song, H.-Y., Chaudhary, P., Spencer, A., Peskin, M. F., Maria, D. S., Wilkerson, J. M., et al. (2020) · JMIR Serious Games · doi:10.2196/23088 · Cited by 20
“The use of a serious gaming strategy may be intrinsically motivating to this population segment, thereby increasing exposure to sexual health content [33].”
Gorp, P. M. E. V., & Nuijten, R. (2023) · Proceedings of the ACM on Human-Computer Interaction · doi:10.1145/3593223 · Cited by 16
“We have focused on this subset of design strategies because several review studies have shown its promise when applied to mHealth apps [12, 15, 21].”
BackgroundSchakel, L., Veldhuijzen, D., van Middendorp, H., Prins, C., Drittij, A. M. H. F., Vrieling, F., Visser, L., Ottenhoff, T., Joosten, S., & Evers, A. (2020) · Journal of Medical Internet Research · doi:10.2196/14861 · Cited by 11
“A meta-analysis showed evidence for the effectiveness of serious gaming in promoting a healthy lifestyle [15].”
Afonso, L., Rodrigues, R., Reis, E., Miller, K. M., Castro, J., Parente, N., Teixeira, C., Fraga, A., & Torres, S. (2020) · IEEE Transactions on Games · doi:10.1109/tg.2020.3015804 · Cited by 18
“Their use has been tested in several randomized controlled trials (RCTs) and a meta-analysis reported their positive effects both in lifestyle and in its determinants [27].”
BackgroundSerious Game on a Smartphone for Adolescents Undergoing Hemodialysis: Development and Evaluation
Santana, C. C. D. A. P., Freitas, A. T. V. D. S., Barreto, G. O., Avelar, I. S. D., Mazaro‐Costa, R., Bueno, G. N., Ribeiro, D. C., Silva, G. D., & Naghettini, A. V. (2020) · JMIR Serious Games · doi:10.2196/17979 · Cited by 15
“A meta-analysis on the promotion of a healthy lifestyle by serious games has shown a positive effect; the most significant benefits were the understanding of clinical results and the maintenance of healthy long-term behaviors [29].”
BackgroundVugts, M. A. P., Joosen, M. C. W., van Bergen, A. H. M. M., & Vrijhoef, H. J. (2016) · JMIR Serious Games · doi:10.2196/games.5088 · Cited by 11
“Accordingly, computer game technology has been applied to engage people and to promote health behaviors and clinical outcomes [16,17].”
Influentialde Almondes, K. M., & Leonardo, M. E. M. (2018) · Frontiers in Psychology · doi:10.3389/fpsyg.2018.01016 · Cited by 14
“In addition, children that sleep next small screens (e.g., smartphones) relate impacts in perception of insufficient rest, probably caused by waking up due to notifications on the small screen (Cain and Gradisar, 2010; Falbe et al., 2015).”
BackgroundSchwarz, A. F., Cardon, G., Chastin, S., Stragier, J., Marez, L. D., & DeSmet, A. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18147444 · Cited by 15
“Serious games are games that are both intended for entertainment and educational purposes [12,13] and have shown to be effective in promoting a variety of health behaviors [14].”
BackgroundSelf-citationMalone, L. A., Davlyatov, G. K., Padalabalanarayanan, S., & Thirumalai, M. (2021) · JMIR Serious Games · doi:10.2196/30672 · Cited by 11
“However, the scope of video gaming has broadened and been shown to provide a role in physical rehabilitation, a tool for health promotion and behavior change, and a means for improving mental health [3-8].”
BackgroundMendonça, T. S., Carvalho, S. T., Aljafari, A., Hosey, M. T., & Costa, L. R. (2024) · Games for Health Journal · doi:10.1089/g4h.2023.0055 · Cited by 16
Schwarz, A. F., DeSmet, A., Cardon, G., CHASTIN, S. F. M., Costa, R., Grilo, A., Ferri, J., Doménech, J., & Stragier, J. (2018) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph15050835 · Cited by 11
Self-citationAn overview of games for entomological literacy in support of sustainable development
Campo, P., & Dangles, O. J. (2020) · Current Opinion in Insect Science · doi:10.1016/j.cois.2020.05.018 · Cited by 13
Postmenopausal women’s cognitive function and performance of virtual reality tasks
Zangirolami-Raimundo, J., Raimundo, R. D., Noll, P. R. E. S., Santos, W., Leone, C., Baracat, E. C., Sorpreso, I. C. E., & Soares, J. M. (2023) · Climacteric · doi:10.1080/13697137.2023.2190511 · Cited by 14
“Furthermore, players showed improvement in lifestyle, self-confidence and self-perception after the programs, resulting in an enhanced quality of life [13].”
BackgroundPromoting Physical Activity and Fitness with Exergames
Kari, T. (2016) · Advances in multimedia and interactive technologies book series · doi:10.4018/978-1-5225-1817-4.ch013 · Cited by 14
Developing and piloting a serious game to educate children about over‐the‐counter medication safety
Abraham, O., Feathers, A. M., Grieve, L., & Babichenko, D. (2019) · Journal of Pharmaceutical Health Services Research · doi:10.1111/jphs.12292 · Cited by 13
“,6 – 16 ] A small sample of students were recruited which limits the statistical validity and clinical implication of the study fi ndings.”
BackgroundIntroducing a mobility on demand system to prospective users with the help of a serious game
König, A., Kowala, N., Wegener, J., & Grippenkoven, J. (2019) · Transportation Research Interdisciplinary Perspectives · doi:10.1016/j.trip.2019.100079 · Cited by 14
“A meta-analysis by DeSmet et al. (2014) found that the majority of the quantitative validation studies produced heterogeneous results and only few showed small overall effects of se-riousgamesonhealthylifestylebehaviour.”
BackgroundSchwarz, A. F., Mertens, L., Simons, M., Spook, J. E., Thompson, D. I., Cardon, G., Bourdeaudhuij, I. D., CHASTIN, S. F. M., & DeSmet, A. (2018) · Games for Health Journal · doi:10.1089/g4h.2017.0178 · Cited by 14
“16,17 Serious digital games for health promotion address a diverse range of health topics, 5 and have to appeal to a broad target group.”
Self-citationTraining Vegetable Parenting Practices Through a Mobile Game: Iterative Qualitative Alpha Test
Brand, L., Beltran, A., Buday, R., Hughes, S. O., O’Connor, T. M., Baranowski, J. C., Dadabhoy, H., Diep, C. S., & Baranowski, T. (2015) · JMIR Serious Games · doi:10.2196/games.4081 · Cited by 13
“Serious games provide a behavioral intervention opportunity to increase child vegetable intake, which has had a positive impact on health-related behavior change [8].”
BackgroundSelf-citationConceptual framework for designing video games for children with type 1 diabetes
Sparapani, V. D. C., Fels, S., Kamal, N. R., & Nascimento, L. C. (2019) · Revista Latino-Americana de Enfermagem · doi:10.1590/1518-8345.2764.3090 · Cited by 14
Editor's choice: Optimizing healthy food preferences by serious gaming
Schakel, L., Veldhuijzen, D. S., Manaï, M., van Beugen, S., van der Vaart, R., van Middendorp, H., & Evers, A. W. M. (2019) · Psychology and Health · doi:10.1080/08870446.2019.1675657 · Cited by 12
Folkvord, F., Haga, G., & Theben, A. (2021) · JMIR Serious Games · doi:10.2196/23050 · Cited by 12
Engaging Children in Story Co-Creation for Effective Serious Games
Menestrina, Z., Pasqualotto, A., Siesser, A., Venuti, P., & Angeli, A. D. (2021) · Sustainability · doi:10.3390/su131810334 · Cited by 16
“Its design-oriented focus suited the space of a game for purpose, and there is evidence that leaner user engagement produced more effective games for healthy lifestyle promotion [8].”
BackgroundEinführung in die Vergangenheit, Gegenwart und Zukunft von Serious Games (for Health)
Tolks, D., Dadaczynski, K., & Horstmann, D. (2018) · Prävention und Gesundheitsförderung · doi:10.1007/s11553-018-0667-9 · Cited by 13
Sparapani, V. D. C., Fels, S., & Nascimento, L. C. (2017) · JMIR Diabetes · doi:10.2196/diabetes.7652 · Cited by 13
“Some studies report the positive effects of using video games on health determinants [10] and clinical outcomes [1].”
BackgroundOpen pilot trial of an interactive digital application for campus sexual violence prevention
Orchowski, L. M., Zinzow, H. M., Thompson, M. P., & Wood, S. (2023) · Journal of Community Psychology · doi:10.1002/jcop.22985 · Cited by 13
Sarasmita, M. A., Lee, Y.-H., Chan, F.-Y., & Chen, H. (2024) · Journal of Medical Internet Research · doi:10.2196/49692 · Cited by 20
“Possible unexpected impacts of SG interventions on aggressive behaviors should also be evaluated, especially for SG interventions that encompass violent elements [62,63].”
Serious Games for Health: The Potential of Metadata
Göbel, S. P., & Maddison, R. (2017) · Games for Health Journal · doi:10.1089/g4h.2016.0034 · Cited by 12
“Overall, research evidence has highlighted the potential of serious games for healthy lifestyle promotion.(12) While the application of advanced gaming concepts and game technology applied to nonleisure contexts (e.”
BackgroundGijzen, M., Rasing, S. P. A., van den Boogaart, R., Rongen, W. C. H., van der Steen, T., Creemers, D. H. M., Engels, R. C. M. E., & Smit, F. (2021) · PLoS ONE · doi:10.1371/journal.pone.0260224 · Cited by 11
“A meta-analysis showed that using serious games for health promotion can lead to small, albeit positive effects in healthy life-style behavior [30].”
BackgroundNorozi, K., Haworth, R., Dempsey, A. A., Endres, K., & Altamirano‐Diaz, L. (2020) · CJC Open · doi:10.1016/j.cjco.2020.07.006 · Cited by 16
Cross‐cultural mobile game evaluation shows improvement in environmental learning, but not behavior
Thomas‐Walters, L., & Veríssimo, D. (2022) · Conservation Science and Practice · doi:10.1111/csp2.12784 · Cited by 12
Carcioppolo, N., Kim, S. Y., Sanchez, M. I., Mao, B., Malova, E., Ryan, A., Lun, D., Ewing, C., & Hu, S. (2022) · Social Science & Medicine · doi:10.1016/j.socscimed.2022.115281 · Cited by 12
Liu, M., Guan, X., Guo, X., He, Y., Liu, Z., Ni, S., & Wu, Y. (2024) · Nutrients · doi:10.3390/nu16091290 · Cited by 12
“Previous studies found that the effects of serious games were the greatest on knowledge [14].”
BackgroundEvaluating the Impact of Gameful Design on Pro-Environmental Attitudes: Beyond Blue as Intervention
Daiiani, M., Sweetser, P., Stanley, S. K., Caldwell, S., & Rooy, D. V. (2024) · International Conference on the Foundations of Digital Games (FDG) · doi:10.1145/3649921.3649933 · Cited by 14
“Very few studies have focused on implicit attitudes (e.g., [55, 64]) and few studies (e.g., [34, 75]) have assessed long-term attitudes in their methodology.”
BackgroundNuijten, R., Gorp, P. M. E. V., Khanshan, A., Blanc, P. M. L., Kemperman, A. D. A. M., van den Berg, P., & Simons, M. (2021) · Electronics · doi:10.3390/electronics10232935 · Cited by 9
Koch, A. K., Mønster, D., Julia Nafziger, B., & Olsen, N. V. (2022) · Food Control · doi:10.1016/j.foodcont.2022.108825 · Cited by 13
Translating open data to educational minigames
Dunwell, I., Dixon, R., Bul, K., Hendrix, M., Kato, P. M., & Ascolese, A. (2016) · International Workshop on Semantic and Social Media Adaptation and Personalization (SMAP) · doi:10.1109/smap.2016.7753400 · Cited by 11
“Games have previously been used around this topic, with examples including dietary education and physical activity [8].”
MethodBennett, J. B., Neeper, M., Linde, B. D., Lucas, G. M., & Simone, L. (2018) · JMIR Mental Health · doi:10.2196/mental.8955 · Cited by 10
“Such features include customization to the user or workplace, interactive elements, regular quizzing, personalized feedback, multimodule information, and psychoeducational resources [31,32,55].”
BackgroundGrenzen von „Serious Games for Health“
Breuer, J., & Tolks, D. (2018) · Prävention und Gesundheitsförderung · doi:10.1007/s11553-018-0654-1 · Cited by 10
Willmott, T. J., Russell‐Bennett, R., Drennan, J. C., & Rundle-Thiele, S. R. (2018) · Health Education & Behavior · doi:10.1177/1090198118780493 · Cited by 13
Vázquez, F. L., Torres, Á., Otero, P., Blanco, V., López, L., García-Casal, A., & Arrojo, M. (2019) · Trials · doi:10.1186/s13063-019-3859-5 · Cited by 11
“In addition, health interventions applied through video games have been shown to be as effective as other non-gamified interventions administered by computer [9].”
BackgroundResultInfluentialDesigning Video Games for Nutrition Education: A Participatory Approach
Leong, C. S.-F., Liesaputra, V., Morrison, C., Parameswaran, P., Grace, D., Healey, D. M., Ware, L., Palmer, O., Goddard, E., & Houghton, L. A. (2021) · Journal of Nutrition Education and Behavior · doi:10.1016/j.jneb.2021.07.001 · Cited by 11
Brüll, P., Ruiter, R. A. C., Wiers, R. W. H. J., & Kok, G. (2016) · Games for Health Journal · doi:10.1089/g4h.2016.0016 · Cited by 13
“31 However, in a recent meta-analysis, 32 DeSmet et al. reported that educational games failed to induce a long-term effect on behavior and stressed the importance of tailoring a game not only toward behavioral outcomes but also taking into account both sociodemographic information (e.g., age,…”
Thomsen, E. K., Hemingway, C., South, A., Duda, K. A., Dormann, C., Farmer, R., Coleman, M. M., & Coleman, M. (2018) · Malaria Journal · doi:10.1186/s12936-018-2572-2 · Cited by 8
Sparapani, V. D. C., Fels, S., Kamal, N. R., Banca, R. O. L., & Nascimento, L. C. (2021) · Journal of Diabetes Science and Technology · doi:10.1177/19322968211017555 · Cited by 14
Abdollahi, A. M., Masento, N. A., Vepsäläinen, H., Mijal, M., Gromadzka, M., & Fogelholm, M. (2021) · Frontiers in Nutrition · doi:10.3389/fnut.2021.674404 · Cited by 14
“It is theorized that the increased intrinsic motivation with gaming stems from immersion, high concentration, challenges and accomplishments throughout the gameplay experience (17, 22), which are quintessential qualities of escape games.”
BackgroundPouls, B. P. H., Bekker, C. L., van Dulmen, S., Vriezekolk, J. E., & van den Bemt, B. J. F. (2021) · JMIR Serious Games · doi:10.2196/31570 · Cited by 9
“Another reason for applying these behavior change techniques was the fact that they have been successfully and effectively gamified [26,27].”
BackgroundTherapeutic Gaming for Adolescent Anxiety
Barnes, S., & Prescott, J. (2021) · Advances in psychology, mental health, and behavioral studies (APMHBS) book series · doi:10.4018/978-1-7998-7991-6.ch009 · Cited by 10
Nørlev, J. T. D., Derosche, C., Sondrup, K., Hejlesen, O. K., & Hangaard, S. (2022) · JMIR Serious Games · doi:10.2196/33955 · Cited by 10
“DeSmet et al [75] reported that games are best tailored to both sociodemographic information (eg, age and gender) and behavioral change needs (eg, knowledge and motivation).”
BackgroundUnlock Me: A Real-World Driven Smartphone Game to Stimulate COVID-19 Awareness
Phutela, N., Chowdhary, A. N., Anchlia, S., Jaisinghani, D., & Gabrani, G. (2022) · International Journal of Human-Computer Studies · doi:10.1016/j.ijhcs.2022.102818 · Cited by 10
Simões, M. D. S., Gonze, B. D. B., Proença, N. L., Lauria, V. T., Terra, V. D. S., Padovani, R. D. C., & Dourado, V. Z. (2019) · Trials · doi:10.1186/s13063-019-3879-1 · Cited by 10
Innovative Treatment Approaches in Gambling Disorder
Snippe, L., Boffo, M., Stewart, S. H., Dom, G., & Wiers, R. W. H. J. (2019) · Springer eBooks · doi:10.1007/978-3-030-03060-5_10 · Cited by 10
Video Games for Positive Aging: Playfully Engaging Older Adults
Godfrey, S. B., & Barresi, G. (2022) · Studies in computational intelligence · doi:10.1007/978-981-16-8488-3_18 · Cited by 9
Davies, V. F., Mafra, R., Beltran, A., Baranowski, T., & Lu, A. S. (2016) · Games for Health Journal · doi:10.1089/g4h.2015.0019 · Cited by 9
“The primary hypothesis of the present article was that children would prefer watching a narrative cartoon to a non-narrative cartoon that simply gave information about PA.”
Self-citationDyck, D. V., D’Haese, S., Plaete, J., Bourdeaudhuij, I. D., Deforche, B. I., & Cardon, G. (2018) · Health & Social Care in the Community · doi:10.1111/hsc.12679 · Cited by 10
Self-citationExperimental Design to Systematically Develop a Knowledge Base for Effective Games for Health
Baranowski, T., Lyons, E., & Thompson, D. I. (2019) · Games for Health Journal · doi:10.1089/g4h.2019.0057 · Cited by 9
“Some investigators have conducted meta-analyses and meta-regression of published outcome evaluations to discern which videogame design elements 2 and behavior change techniques 18 have had the desired behavioral effects.”
Self-citationMelanoma prevention using an augmented reality-based serious game
Ribeiro, N., Tavares, P., Ferreira, C., & Coelho, A. F. (2024) · Patient Education and Counseling · doi:10.1016/j.pec.2024.108226 · Cited by 9
Demircan, B., & Kaya, H. (2025) · Nurse Education in Practice · doi:10.1016/j.nepr.2025.104341 · Cited by 8
Metadata
- 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)
- 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
- FWCI
- 5.28
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- 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 › Communication › 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
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