Talking with Debra Lieberman: Building the research on how games improve health

Today, we continue our discussion with Debra Lieberman to learn more about how Health Games Research is working to advance the research and design of health games and is contributing to building the health games field.

Debra, yesterday you introduced us to Health Games Research and its efforts to build the research for the health games field. Today, can you share any examples of games that highlight the potential for games to improve health?

Two games, both that I helped design, come to mind.  The first is Packy & Marlon.  Made for the Super Nintendo platform in the mid-1990’s, Packy & Marlon is a diabetes self-management game that was designed to reduce the stigma of diabetes among children and teens, increase their diabetes knowledge and self-care skills, foster communication with family and friends and improve self-efficacy for diabetes self-management.  The game centers on two diabetic elephants, Packy and Marlon, who arrive at diabetes summer camp and discover that rats and mice have marauded the camp and scattered all the food and diabetes supplies.  Players, taking the role of the two elephants, must search through the mountains, rivers, forests, playgrounds and haunted cabins to find these items, select a balanced diet of three meals and three snacks a day, measure their blood glucose and take insulin. 

We conducted a clinical trial with diabetes outpatients, ages 8 to 16. Participants were given a Super Nintendo console and were randomly assigned to receive Packy & Marlon or an entertainment video game that had no health content.  After six months of having the game at home, there was no change in number of annual diabetes-related urgent care and emergency room visits among the group that received the entertainment game. We found that the treatment group that received Packy & Marlon reduced their urgent care and emergency room visits by 77 percent.

 The second Nintendo game I helped design is the asthma self-management game, Bronkie the Bronchiasaurus.  In this game, players take on the role of Bronkie, a male dinosaur, or Trakie, a female dinosaur,  who are trying to save their planet and recover a mighty wind machine that keeps away deadly dust. The characters have asthma and the player must guide them through the game where they have to avoid asthma triggers, such as dust, pollen, smoke, furry animals, and sneezer characters who intermittently sneeze out cold viruses.  Players must check their character’s peak flow (breath strength) and take medications if they have bumped into too many triggers.  The asthma-related activities in the game provide almost unlimited opportunity to rehearse asthma self-management skills. The game was tested in clinical trials and found reductions in player's asthma-related urgent care and emergency visits of about 40 percent. The game also reduced children’s missed school days and parents’ missed workdays due to their child’s asthma by about 40 percent as well.

Another well known and well-researched health game is the cancer education game, Re-Mission. Designed to explore the inside of various cancer patients’ bodies, the player takes the role of a nanobot named Roxxi, who blasts away cancer cells with chemotherapy and delivers other treatments to the patient. Clinical trials found that the game increased cancer patients’ cancer knowledge, self-efficacy for cancer self-care, and adherence to one’s treatment plan.

How are you hoping to engage health care providers and game developers in the work of Health Games Research and its grantees?

Health Games Research aims to improve the quality and impact – and of course, the quantity – of basic research that will help us understand how people respond to specific features of health games cognitively, emotionally, socially and physically. This will help us discover principles of health game design to use in developing future games. We want this research to stimulate more interest and involvement in the field, and to set high standards of quality for research and for health games.      

We know that health care providers want evidence that treatments they recommend to their patients are efficacious—that they work. If a health care provider is going to prescribe a game to their patients, or implement games in their clinics, they’re going to want to know if those games work, include current medical information and were designed with state-of-the-art techniques. They need data in order to take a game seriously.  To engage health care providers, we must be able to respond to their requirements for data and evidence regarding a particular game’s effectiveness and, more generally, we must be able to show them the wide variety of health games and their benefits and clinical outcomes as evidenced in research so far.

This type of research is essential in the health care industry, but it is usually not required in the game publishing industry, so it is our job to demonstrate the benefits of applying research toward the design and production of games meant to change health behaviors.   We want to encourage game developers to invite researchers and behavioral health specialists to be part of the design team, even at the earliest stages of game design, to help determine the goals of the game and to use theory and research findings as the basis for health-related design decisions. Without dampening a game’s creative spirit and uniqueness, the goal is to integrate game design elements that are known to improve health.

Check back tomorrow for part three of our interview with Debra Lieberman and an update on the work of the current round of Health Games Research grantees.