Integrating Health Behavior Theory and Design Elements in Serious Games
Open accessAbstract
Background: Internet interventions for improving health and well-being have the potential to reach many people and fill gaps in service provision. Serious gaming interfaces provide opportunities to optimize user adherence and impact. Health interventions based in theory and evidence and tailored to psychological constructs have been found to be more effective to promote behavior change. Defining the design elements which engage users and help them to meet their goals can contribute to better informed serious games. Objective: To elucidate design elements important in SPARX, a serious game for adolescents with depression, from a user-centered perspective. Methods: We proposed a model based on an established theory of health behavior change and practical features of serious game design to organize ideas and rationale. We analyzed data from 5 studies comprising a total of 22 focus groups and 66 semistructured interviews conducted with youth and families in New Zealand and Australia who had viewed or used SPARX. User perceptions of the game were applied to this framework. Results: A coherent framework was established using the three constructs of self-determination theory (SDT), autonomy, competence, and relatedness, to organize user perceptions and design elements within four areas important in design: computer game, accessibility, working alliance, and learning in immersion. User perceptions mapped well to the framework, which may assist developers in understanding the context of user needs. By mapping these elements against the constructs of SDT, we were able to propose a sound theoretical base for the model. Conclusions: This study’s method allowed for the articulation of design elements in a serious game from a user-centered perspective within a coherent overarching framework. The framework can be used to deliberately incorporate serious game design elements that support a user’s sense of autonomy, competence, and relatedness, key constructs which have been found to mediate motivation at all stages of the change process. The resulting model introduces promising avenues for future exploration. Involving users in program design remains an imperative if serious games are to be fit for purpose.
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Previous studies have emphasized the need for efforts to treat impairments outside the therapy context and provide patients with greater autonomy.
“ADHD is a chronic health problem and previous studies have emphasized the need for efforts to treat impairments outside the therapy context and provide patients with greater autonomy [22,23,63].”
Easy accessible interventions such as serious games can stimulate young patients with ADHD to comanage their health care processes.
“Given that young patients with ADHD have engagement and motivation issues in general, easy accessible interventions such as serious games can stimulate them to comanage their health care processes as part of the Chronic Care Model of Child Health and the World Health Organization Mental Health Action Plan 2013-2020 [22,23,64].”
ADHD is a chronic health problem.
“ADHD is a chronic health problem and previous studies have emphasized the need for efforts to treat impairments outside the therapy context and provide patients with greater autonomy [22,23,63].”
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- Authors
- Cheek, C., Fleming, T., Lucassen, M. F., Bridgman, H., Stasiak, K., Shepherd, M., & Orpin, P.
- Affiliations
- University of Tasmania (AU)
- University of Auckland (NZ)
- Corresponding author
- Cheek, Colleen
- ORCID
- Venue
- JMIR Mental Health
- Publisher
- JMIR Publications Inc.
- Published
- 2015-04-21
- Volume
- 2
- Issue
- 2
- Pages
- e11
- ISSN
- 2368-7959 (ISSN-L)
- PMC
- PMC4607397
- OpenAlex
- W2102505751
- Cited by
- 95
- References
- 53
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 10 · 2023: 5 · 2022: 10 · 2021: 14 · 2020: 17 · 2019: 8 · 2018: 12 · 2017: 5 · 2016: 6 · 2015: 3
- FWCI
- 21.80
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- JMIR Mental Health (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- eCite Digital Repository (University of Tasmania) (submittedVersion)
- Figshare (submittedVersion)
- Funders
- University of Tasmania
- University of Auckland
- Topics
- Social Sciences › Psychology › Developmental and Educational Psychology › Educational Games and Gamification
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Physical Sciences › Computer Science › Human-Computer Interaction › Innovative Human-Technology Interaction
- Keywords
- serious games, SPARX, adolescent depression, self-determination theory, game elements, user-centered design, health behavior change, autonomy, competence, relatedness, motivation, online intervention, user perception, therapeutic relationship, immersion, accessibility
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