Conceptual Ambiguity Surrounding Gamification and Serious Games in Health Care: Literature Review and Development of Game-Based Intervention Reporting Guidelines (GAMING).

Scott Thiebes,Manuel Schmidt-Kraepelin,Ali Sunyaev,Sascha Rank,Simon Warsinsky

doi:10.2196/30390

Abstract

BackgroundIn health care, the use of game-based interventions to increase motivation, engagement, and overall sustainability of health behaviors is steadily becoming more common. The most prevalent types of game-based interventions in health care research are gamification and serious games. Various researchers have discussed substantial conceptual differences between these 2 concepts, supported by empirical studies showing differences in the effects on specific health behaviors. However, researchers also frequently report cases in which terms related to these 2 concepts are used ambiguously or even interchangeably. It remains unclear to what extent existing health care research explicitly distinguishes between gamification and serious games and whether it draws on existing conceptual considerations to do so.ObjectiveThis study aims to address this lack of knowledge by capturing the current state of conceptualizations of gamification and serious games in health care research. Furthermore, we aim to provide tools for researchers to disambiguate the reporting of game-based interventions.MethodsWe used a 2-step research approach. First, we conducted a systematic literature review of 206 studies, published in the Journal of Medical Internet Research and its sister journals, containing terms related to gamification, serious games, or both. We analyzed their conceptualizations of gamification and serious games, as well as the distinctions between the two concepts. Second, based on the literature review findings, we developed a set of guidelines for researchers reporting on game-based interventions and evaluated them with a group of 9 experts from the field.ResultsOur results show that less than half of the concept mentions are accompanied by an explicit definition. To distinguish between the 2 concepts, we identified four common approaches: implicit distinction, synonymous use of terms, serious games as a type of gamified system, and distinction based on the full game dimension. Our Game-Based Intervention Reporting Guidelines (GAMING) consist of 25 items grouped into four topics: conceptual focus, contribution, mindfulness about related concepts, and individual concept definitions.ConclusionsConceptualizations of gamification and serious games in health care literature are strongly heterogeneous, leading to conceptual ambiguity. Following the GAMING can support authors in rigorous reporting on study results of game-based interventions.

Highlights

Health interventions that draw on games as their inspirational source come with the promise of increasing motivation, engagement, and overall sustainability of health behaviors [1] by enabling new paths of interactions between health care providers and patients [2]
We argue that more practical guidelines for authors to avoid ambiguities between different types of game-based interventions can help achieve a more accurate attribution of cognitive, affective, and behavioral outcomes to either gamification or serious games and advance the development of effective interventions
We provide a comprehensive overview of existing conceptualizations of gamification and serious games in health care (RQ1) and provide rich insights into the nature of the conceptual unclarities surrounding gamification and serious games (RQ2)

Summary

Introduction

Health interventions that draw on games as their inspirational source (ie, game-based interventions) come with the promise of increasing motivation, engagement, and overall sustainability of health behaviors [1] by enabling new paths of interactions between health care providers and patients [2]. A myriad of different labels for game-based interventions have emerged, including playification [4], educational games [5], game-based learning [6], active video games [7], fitnessification [8], fitness games [9], exergames or serious exergames [10], cognitive games [11], simulation games [12], games with a purpose [13,14], persuasive information systems [15], and persuasive games [16] Among these approaches to game-based health interventions, gamification and serious games have emerged as the 2 prevailing concepts [13,17,18]. We conducted a systematic literature review of 206 studies, published in the Journal of Medical Internet Research and its sister journals, containing terms related to gamification, serious games, or both We analyzed their conceptualizations of gamification and serious games, as well as the distinctions between the two concepts. Following the GAMING can support authors in rigorous reporting on study results of game-based interventions

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