Games in Health and Education

Up to this point, we have reviewed a diverse set of potentialbenefits of gaming relevant to children’s cognitive, motivational, social, and emotional development. The medicalfield has picked up on these positive effects and becomeincreasingly interested in “gamifying” medical interventions (Ritterfeld, Cody, & Vorderer, 2009), as evidenced bythe emergence of a new journal (Games for Health Journal), calls for proposals from major granting agencies (e.g.,the National Science Foundation, the European ResearchCouncil), and some highly successful “serious games” thathave made international headlines for their promising outcomes. Researchers and practitioners alike in the medicalfield have begun to harness the power of video games tomotivate patients and, ultimately, to improve their healthoutcomes (for a review, see Kato, 2010).Perhaps the most celebrated success story of a gamethat had a significant impact on health-related behaviors isthe case of Re-Mission (Kato, Cole, Bradlyn, & Pollock,2008), a video game designed for child cancer patients. Byallowing the player to control a nanobot who shoots cancercells, overcomes bacterial infections, and manages signs ofnausea and constipation (common barriers to cancer patients’ treatment adherence), the game aimed to teach children how best to adhere to their cancer treatments. Arandomized controlled study conducted internationally in34 medical centers compared children assigned to playRe-Mission to a control group of children playing anothercomputer game (Kato et al., 2008). Adherence to treatmentprotocol, self-efficacy, and cancer-related knowledge wereall significantly greater in the intervention group. The gamehas now been distributed to over 200,000 patients andcontinues to be viewed as a successful treatment approach.The promise of video games has also made a great stirin the field of education. Space limitations preclude areview of the myriad games developed to improve educational outcomes in almost every subject taught in schools.Several reviews already exist on the learning outcomes.

associated with educational games (e.g., O’Neil, Wainess, & Baker, 2005), and a meta-analysis concluded that games can make important advances in the educational reform necessary to deal with the learning challenges of the next century (Vogel et al., 2006). Despite the emerging hype regarding the “gamification” of interventions in the health and educational sciences, caution is also warranted. The most important reason is that very few of the games developed to improve health and learning outcomes are ever scientifically evaluated. As a result, it is still unknown how much more effective these games are in changing behavioral and health outcomes than are conventional approaches. The second shortcoming is that medical practitioners, teachers, and researchers are not game designers, and as a result, they often develop products that miss the most essential mechanism of engagement in games—the fun. In an effort to pull together a set of valid principles or lessons, games for health and education often end up with the “chocolate-covered broccoli” problem—the games look great, they are good for you, but they ultimately fail to work because the creative game dynamics that induce transportation and immersion are missing, making them simply not fun. We highlight these shortcomings in the domain of games for health in particular because the same cautionary notes should be taken seriously if (and when) psychologists consider developing games for mental health. We now turn to a discussion of more general limitations of the gaming literature and attempt to address these limitations with suggestions for novel research directions.

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