1. Pediatrics
NIDDK
NATIONAL INSTITUTE OF
DIABETES AND
DIGESTIVE
AND KIDNEY DISEASES
NATIONAL INSTITUTE
OF HEALTH
Eunice Kennedy Shriver
NICH
D
HP Live - Webinar May 17, 2013 – 11:00 am CDT
Professor of Pediatrics (Behavioral Nutrition & PA)
USDA/ARS Children’s Nutrition Research Center
Baylor College of Medicine
Houston, Texas, 77030, USA
www.bcm.edu/cnrc/faculty/?PMID=9519
Games for Health
with
Tom Baranowski, PhD

2. Games for Health
HP Live – Webinar
May 17, 2013 – 11:00am CDT
Chronic Illnesses/Obesity Treatment
• Regimen Adherence has been low
– often 50% or less
Chronic Illnesses/Obesity Prevention
• Behavior Change has been small
– if at all
Need alternatives to usual approaches?

3. Games for Health
HP Live – Webinar
May 17, 2013 – 11:00am CDT
Videogames (Serious VG/VG for Health)
• Have story and interactivity to
engage/immerse/transport players
• Can incorporate behavior change or health
change procedures
• Can incorporate feedback and rewards to
motivate change
• Has “fun” to maintain game play

4. Games for Health
HP Live – Webinar
May 17, 2013 – 11:00am CDT
“Playing for Real” (Baranowski et al AJPM 2008)
• All 28 games reviewed showed evidence of
change in the desired direction
• We have developed and evaluated several
games for health

5. Games for Health
HP Live – Webinar
May 17, 2013 – 11:00am CDT
Diab Trailer

6. Games for Health
HP Live – Webinar
May 17, 2013 – 11:00am CDT
Preliminary Process Model of
Behavior Change from Games
Demographics
Pregame
Characteristics
Motivation
to Play
Video
Game
PsychosocialVariables:
Motivation to
Continue Playing
Game
Exposure
to Video
Game
Immersion
Success?
Fun?
Practical
Knowledge
of Behavior
for Change
Behavior
Change
Skill
Development
Behavioral
Self Control
Skill
Development
- Include Asking
Motivation
to Change
Behavior
Physical
Resources
Barriers to
Change
Behavior
Change
Attempts
Continued
Behavior
Change
Attempts
HabitSuccess
Fun?
Challenging
Success
…Time…
Home
Accessibility/Availability
Attention
to Video
Game
Activities
Central
Processing

7. Games for Health
HP Live – Webinar
May 17, 2013 – 11:00am CDT
Model Incorporates Elements of:
• Self Determination Theory
• Elaboration Likelihood Model
• Social Cognitive Theory
• Transportation Theory (Immersion)

8. Games for Health
HP Live – Webinar
May 17, 2013 – 11:00am CDT
Process Model of Possible Mechanisms for
Children’s Dietary and Physical Activity Change in
Video Games
Demographics
Pregame
Characteristics
Motivation
to Play
Video
Game
PsychosocialVariables:
Game Activities:
Motivation to
Continue Playing
Game
Exposure
to Video
Game
Immersion
Attention
to Video
Game
Activities
Success?
Fun?
Practical
Knowledge
of Behavior
for Change
Story
-Modeling
Behavior
-Modeling
Overcoming
Barriers
- Moral of Story
Behavior
Change
Skill
Development
Behavioral
Self Control
Skill
Development
- Include Asking
Simulation
with Feedback
Motivation
to Change
Behavior
Self Control
Activities
-Goal Setting
• action
• coping
-Problem
Solving
-Automation
Physical
Resources
Barriers to
Change
Behavioral
Innoculation
Procedures
Behavior
Change
Attempts
Tailored Motivational
Messages
-Outcome Expectancy
-Values/Reasons
Continued
Behavior
Change
Attempts
HabitSuccess
Knowledge
Games
Fun? Challenging
Success
Central
Processing
…Time…
Home
Accessibility/Availability

9. Games for Health
HP Live – Webinar
May 17, 2013 – 11:00am CDT
Squire’s Quest!

10. Games for Health
HP Live – Webinar
May 17, 2013 – 11:00am CDT
Squire’s Quest! Evaluation Design
• 1600 4th grade students in 26 schools
• Cluster randomized trial
• Pre & post assessment
• Multiple 24hour recalls – FIRSSt
• Treatment: SQ!; no intervention control

11. Games for Health
HP Live – Webinar
May 17, 2013 – 11:00am CDT
Squire’s Quest! Outcomes
• Increased FV intake by 0.9 servings
• Changes occurred at snacks (fruit), lunch
(vegetable)
– Need more work on breakfast, dinner
• Attain recipe prep goals → more FV consumption

12. Games for Health
HP Live – Webinar
May 17, 2013 – 11:00am CDT
GEMS – Fun Food & Fitness

13. Games for Health
HP Live – Webinar
May 17, 2013 – 11:00am CDT
Boy Scout 5-A-Day & FFL Badges

14. Games for Health
HP Live – Webinar
May 17, 2013 – 11:00am CDT
Fit For Life Boy Scout Badge Program
(R Jago et al Prev Med 2006)
• Meeting + internet based
– Skill building
– Comic character modeling + goal setting
• Spring intervention
– + 12 minutes LPA
– - 12 minutes SB
• Not fall intervention (?)

15. Games for Health
HP Live – Webinar
May 17, 2013 – 11:00am CDT
Escape from Diab

16. Games for Health
HP Live – Webinar
May 17, 2013 – 11:00am CDT
Nanoswarm: Invasion from Inner Space

17. Games for Health
HP Live – Webinar
May 17, 2013 – 11:00am CDT
Diab/Nanoswarm Outcomes
• + 1.0/+0.67 FV serving at 2 months post
(p<0.000)
• + 7/0 min MVPA at immediate post (p=0.107)
• No differences in BMI or mediators
• No moderators
• 80-90% enjoyed playing Diab/Nano

18. Games for Health
HP Live – Webinar
May 17, 2013 – 11:00am CDT
Active Video games – Wii Study

19. Games for Health
HP Live – Webinar
May 17, 2013 – 11:00am CDT
Active Video Games – Wii Study Design
l Stratified by mother reported neighborhood safety (not
working)
l 7 days accelerometer readings at 5 times
l Children keep Wii console if provide complete data
l No differences across groups or time
l 700+ media releases around the world
AV1 AV2
MidBaseline (wk 1)
Wk 6 Wk 6
Post
R
E
C
R
U
I
T
M
E
N
T
Wk 1 Wk 1
Wk 1 Wk 1Wk 6 Wk 6IV1 IV2

20. Games for Health
HP Live – Webinar
May 17, 2013 – 11:00am CDT
Parenting Game

21. Games for Health
HP Live – Webinar
May 17, 2013 – 11:00am CDT
Innovative: V Parenting Game
• “Train” Parents → Effective V Parenting
Practices
• Simulation with feed back → learn to fly planes
• Simulate interaction with child with feedback
– Child resistant to V intake
– Parent offered parenting practice options at
interaction points
• 2 effective; 2 ineffective
• Keep selecting until select effective
• See child response
– Algorithm governs interaction
– Tailor child responses to child temperament

22. Games for Health
HP Live – Webinar
May 17, 2013 – 11:00am CDT
Future Research Needs
• Just learning how to capitalize on VG
• Vary VG intervention procedures
• Vary story components to assess how story
influences immersion and attention to game
components

23. Games for Health
HP Live – Webinar
May 17, 2013 – 11:00am CDT
Future Research Needs
• Fun = IM?
– Active involvement (interactivity)?
– Overcoming challenges
– Making choices
– Observing consequences without real threat
– Increasing difficulty
– Personally relevant story & characters in
meaningful situations
• How can we maximize “fun” to maximize
health behavior change?

24. Games for Health
HP Live – Webinar
May 17, 2013 – 11:00am CDT
Games for Health Journal
Research, Development and Clinical Applications
• Only journal devoted to Games for Health
• Editorial Board
– international
– health industry
– academic
– game industry
– Government
• June 2013: Volume 2, Issue 3 (6 issues/year)
– Special issue devoted to Games and
Childhood Obesity

25. Games for Health
HP Live – Webinar
May 17, 2013 – 11:00am CDT
Recent Topics
• Reviews of the effectiveness of games for
health
• Innovative game components, e.g.
computational intelligence
• Business models for G4H
• Exergame effectiveness among seniors,
physically challenged
• Games to enhance mental health
• Game design issues to enhance health behavior
change
• Health professional training games

26. Games for Health
HP Live – Webinar
May 17, 2013 – 11:00am CDT
Dêkuji! (Czech)
DANKE! (German)
MUITO OBRIGADO! (Portuguese)
M G̀ÒI! (Chinese, Cantonese)
ARIGATŌ! (Japanese)
MERCI BEAUCOUP! (French)
MUCHAS GRACIAS! (Spanish)
SERDECZNIE DZIĘKUJĘ! (Polish)
SHUKRAN! (Arabic, Middle East)
TACK SÅMYCKET! (Swedish)
TAKK! (Norwegian)
EFcHARISTo! (Greek)
Xie Xie! (Chinese, Mandarin)
Dank u wel (Dutch)
Khawp Khun maxh! (Thai)
Grazie! (Italian)