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A growing body of research into how people are using video games to manage their health may give payers, providers, patients, and software developers some clues about what it takes to improve health while simultaneously reducing costs.

“Video games can change people in fundamental ways that can lead to better health behaviors,” Debra Lieberman, Ph.D., director of the Health Games Research national program, tells Inside Healthcare IT.  “For example, well designed games can change people’s perceived risk for experiencing serious health problems, their sense of self-efficacy, or self confidence, that they can carry out specific health behaviors successfully, and their perceptions of social norms. These and many other changes in people’s attitudes, emotions, understanding, and skills can tip the balance toward behavior change. While games can be fun and can teach health facts, they can do a great deal more to motivate and support better health.”

Lieberman, a communication researcher at the University of California, Santa Barbara, focuses on processes of learning and behavior change with interactive media, with special interests in games, health media, and children’s media.  After two decades of conducting research on health games she has consistently found that their impact on health can be dramatic.

With her expertise in behavioral health and media research, she helped design several Super Nintendo health games in the early 1990s for smoking prevention, diabetes self-management, asthma self-management, and other health topics, in her role as vice president of research at a Silicon Valley health software company that foresaw the vast potential of entertainment games to motivate health behavior change. 

Packy & Marlon, the diabetes self-management game she helped develop, challenged players to play the role of diabetic characters who confront exciting game challenges at diabetes summer camp. To win the game, players must keep their blood glucose in the normal range through frequent blood glucose monitoring, healthy eating, and use of insulin.

A randomized clinical trial of Packy & Marlon found that the diabetic children and teens enrolled in the study had a diabetes-related urgent care or emergency room visit about 2 ½ times per year on average before the six-month study began.  In the study, all participants were given a Super Nintendo console and were randomly assigned to take home either the Packy & Marlon diabetes self-management game or an entertainment game that had no health content,  to play as much or as little as they wished for six months as long as they followed family rules about video game playing. After six months, the average number of annual urgent care and emergency visits for the participants who had the Packy & Marlon game at home dropped to an average of half a visit per participant per year,  a 77 percent decrease.  The game also improved participants’ diabetes-related knowledge, self-efficacy, and communication with peers and family members.

However, study participants who were given an entertainment game to take home remained at an average of 2 ½ visits per participant per year over the six-month period.  Their clinical utilization for diabetes-related emergencies did not improve at all and they did not experience the other improvements in knowledge, self-efficacy, and communication that were observed in the participants who played the diabetes self-management game.

“If an HMO bought the game for each of its diabetic patients and could save an average of two urgent care and emergency visits per participant per year, that would be a huge improvement in health outcomes and cost savings,” Lieberman says.

But how can games have such a positive impact on health self-management? Lieberman says it is partly due to the challenges that games offer, which can be compelling and fun. 

Games provide all the interactivity and production values that can be found in other forms of digital media, and they also have the added appeal of challenging the player to reach a goal.  Games are experiences that engage the player cognitively, emotionally, socially, and even physically.  They provide feedback on the player’s progress toward the goal and they immerse the player in new worlds and adventures.  A well designed health game addresses the individual’s abilities, interests, and aspirations in ways that can help translate game behaviors into the activities of daily life. This is true for story-based games in which the player controls a game character, and also for physically challenging active games.

For example, active games played on the Wii and Kinect platforms are now widely used to help deliver physical therapy.  Physical therapists are discovering that these active games motivate patients not only to do their exercises but also to work on them with more exertion and for longer periods of time, compared to traditional forms of physical therapy. “The games’ challenge to reach a goal keeps people motivated and engaged,” Lieberman says.

Games can also supplement and extend traditional physical therapy. “One of our Health Games Research grantees at the University of South Carolina is studying the use of active games with stroke victims. After a stroke, many patients’ health insurers will set limits on the amount of physical therapy they will cover.  Games offer a way to continue therapy beyond what’s covered by an insurance plan.”

While video games used to get a bad rap for promoting violence, stereotypes, and a sedentary lifestyle, Lieberman says that well designed games avoid most of these problems and instead provide healthy and constructive alternatives.

“As healthcare providers, educators, and other decision-makers began to see research findings demonstrating that video games can influence desirable attitudes and behaviors, the perception of ‘video-games-as-evil’ has started to change.”

With the advent of new active game platforms such as Wii and Kinect, dance pads for games like Dance Dance Revolution, and outdoor active games guided by mobile technologies and sensors such as Zamzee, games can get people moving and more engaged in exercise.

“There is some evidence that active games can encourage people who are completely sedentary to begin to participate in physical activity because the games get them up off the couch to have fun, help them develop confidence in their ability exercise, and make them feel better physically, so they then seek out more opportunities because they want to continue to enjoy the benefits and invigoration of being active,” Lieberman says. “Active games can be gateways that lead people to try out a wider range of physical activities and, while we need more research on the Gateway Effect, at this point we’re hearing many people say that they’re experiencing it.”

Lieberman says caregivers have used games to help patients manage pain or ease anxiety. “When burn victims are having their dressings changed, playing a video game can help distract them from the pain. When young children are on the operating table and are anxious about being anesthetized, playing a handheld video game can help distract them as well.”

Patients aren’t the only ones benefitting from health games.

For example, Los Altos Hills, CA-based CliniSpace has created a virtual, immersive, 3-D learning environment for clinicians that includes an examination room, a ward, urgent care, emergency bays, and intensive care, as well as support spaces such as a conference/briefing room and a reception area. When users log in, they encounter realistic scenarios and problems that clinicians face, and this includes saving patients’ lives in the emergency room. They practice alone and in teams, learning to make decisions, communicate effectively, deliver medical care, and recover safely from errors.

“There are also simulation games that enable hospital staff to rehearse their responses to unusual scenarios such as epidemics or natural disasters, where the hospital must go into a completely different mode to use its resources to serve a large influx of patients,” explains Lieberman. “The simulations and virtual worlds in these games allow hospital staff to rehearse new protocols, develop skills, and see the effects of their decisions.”

Lieberman hopes that the future will bring more research and research funding into the health games arena and she encourages people from the medical, game development, technology, research, and business communities to get involved. “We need a wide range of brilliant, creative, and entrepreneurial people to join our field and help move it forward.”

Sidebar: About Health Games Research

Funded by an $8.25 million grant from The Robert Wood Johnson Foundation’s Pioneer Portfolio, Health Games Research (http://www.healthgamesresearch.org) is a national program that that provides scientific leadership and resources to advance the research, design, and effectiveness of digital games and game technologies that promote health. It is currently funding 21 research projects that focus on discovering theory-driven, evidence-based strategies for designing games and game technologies that will promote and improve players’ health behaviors and health outcomes.

The types of games studied with funding from Health Games Research are games that improve health either by requiring physical activity in order to play the game or by enhancing the player’s health-related knowledge, skills, attitudes, self-concepts, and social support that could lead to better prevention and self-care behaviors.

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Health Games Research has also developed an online searchable database that enables researchers, game developers, health professionals, educators, funding agencies, policy makers, and the general public to access in one place a wide-ranging compilation of health games, research findings, publications, resources, organizations, and events in this growing field. The database, which is available on the Health Games Research website, is searchable by keyword, category, or topic.

 Copyright 2012 Algonquin Professional Publishing, LLC