Fritz, Huang, Murphy, and Zimmermann did a longitudinal study on fitness trackers using wearable devices in three different continents. The wearables became a part of them and they felt strange when they took it off.
However most of them lost interest when the novelty wore off and the monitoring became routine. The purpose differs from entertainment oriented video games but this does not mean that it cannot be fun or joyful to play.
In addition, Marsh argues that not all videogame characteristics, such as challenge, fun and play, are appropriate descriptions or labels for all serious games. Taken together their findings suggest that there is much room to design more suitable serious games to support specific goals.
This would also suggest that more incorporation of co-design and user centred design in gamification for healthcare could prove to be a critical success factor in the update and continued use of this games in this context. Deterding, Dixon, Khaled, and Nacke divide the world in a playing world and a non-playing context.
In this paper we instead see an entertainment-oriented and a goal-oriented approach to game design. In-between we see entertainment games that are partially used for real-life purposes and real-life games that become more fun.
Garris, Ahlers, and Driskell developed a game model in which they call the in-between group instructional games. Hamari et al. They conclude that serious games must challenge and engage the players for better learning.
Kiili also focuses on flow. Flow is seen as challenges versus capabilities of the player. An interesting aspect is that feedback is both part of the flow task as well as the flow artefact indicating that adding feedback to entertainment games can give a learning effect. Transformational learning can be the bridge, communicating the power of games Barab et al.
Furthermore, the positioning of the person and content are closely linked Sousa et al. Most researchers focused their study on different purposes of serious games. There has been a lot of research in the effectiveness of serious games in teaching-learning related processes. For example, Buchinger and Hounsell reviewed a list of collaborative-competitive serious games in the teaching-learning process.
They mentioned 9 important design features: intra players interaction, synchronization, roles, resources, score, challenge, reward, Artificial Intelligence and operationalization. This study will focus on the motivational purpose of serious games to create consciousness and behaviour change. In the next section we introduce the adopted research method. In line with the set of principles for conducting critical research in information systems as discussed by Myers and Klein , our research consists of elements of critique as well as of transformation.
We question the actual adoption and effectiveness of wearables and serious games - the principle of revealing and challenge prevailing beliefs and social practices - by making use of the IT adoption model as discussed in the previous section based on insights from innovation and adoption researchers like Davis, Bagozzi, and Warshaw , DeLone and McLean , Rogers and Venkatesh et al.
We study how the adoption of serious wearable games can be improved - the principle of taking a value position - in order to help improve health on both an individual and societal level - the principles of individual emancipation and improvements in society - and try to improve diffusion models for serious games by identifying habit as a potential dependent variable for the intention to use wearables - the principle of improvements in social theories.
The emphasis on relevance in the interview method used leads to a value position critical theorists advocate. Finally the principle of revealing and challenging prevailing beliefs and social practices is well established in this paper by choosing a society problem Obesities and Diabetes and explore behavioral change with help of wearables and serious games.
This study is aimed at health improvements in society and provides a theory improvement with a new model for diffusion of serious games. For attaining these research goals, a mixed method approach was adopted.
After performing the literature study, we conducted 97 semi-structured interviews with actual owners and users of wearables. The initial group of interviewees was very diverse with users of different ages, backgrounds and education levels. In order to make the results more generalizable and the interview sample more homogenous we made use of the so-called drilldown technique. This was accomplished by focusing on interviewees that can be regarded as the most active users, i. In order to focus our analysis on a homogeneous group of early adopters Rogers, ; Yin, , we developed a subset of 20 interviews which where analysed in-depth.
The majority of the interviewees a were highly educated b had experience with technology in general and ICT in particular and c were willing to voluntarily adopt new technologies such as wearables. The other 77 interviews were used for the requirements of the wearables and the serious game for diabetes and obesities.
After getting a better insight in the adoption of wearables based on a sentiment analysis, we designed a specific game artefact based upon interviews with 97 potential users in a wide age scale and demonstrated the artefact in a student environment during a 10 week testing period.
Before doing a second iteration, we conducted another 32 interviews to validate the first prototype of the game, especially on diffusion possibilities of the game. Our study can be regarded in sum as a qualitative study of diffusion of wearables and serious games; we did not focus on the specifics of the serious game itself i. This following section describes the objective descriptive data as given by the interviewees. This is followed in the subsequent section by a sentiment analysis and comparison to literature.
Pedometers, sportwatches, Pebble and Fitbit made up the rest. The primary purpose of using wearables seems to be for the monitoring of steps and heart rate Fig. Analysis of sleep was mentioned by three interviewees, of whom two were interested in the amount of sleep while the third was interested in the rhythm of sleep. Nearly twenty five percent of the interviewees mentioned that they would like to have an extension of their smartphone as part of their wearable. Two interviewees mentioned that they want to have a stand-alone device having its own internet access and own GPS.
Two mentioned that they would like to be able to monitor blood pressure. A Fitbit user also mentioned wanting to have more functionality with regards to movement. Essentially there was consensus that wearables needed to be more comprehensive and standalone. When queried on the crucial factors for the use of wearables nearly twenty five percent of the interviewees identified additional value and ease of use as being important Fig.
Twenty percent of the respond mentioned reliable data and personal interest either in new technology or from a hobby point of view.
Lifespan of battery was of importance to fifteen percent. Only ten percent mentioned health , communication , behaviour change and stand-alone device as being important. The adoption of serious games is predicated on a number of factors as illustrated in Fig. Although the structured analysis is very positive, showing a high probability of diffusion, the emotional analysis shows some limitations that the next design must overcome.
The emotional analysis is given in quotes:. The analysis shows that the next iteration should take care of age differences and preferences and the interaction with the game should be as easy as possible. We should reconsider to call it a game or an app. In Fig. On nutrition and relaxation they were not that sure both in measuring and using it.
What is unique and interesting about our research findings includes the notion of habit as a new determinant for the diffusion of serious games. The institutionalisation of the serious game is an important factor to make the serious game a lasting success. The dynamics of the game will improve the flow and will prevent the treatment to become boring.
The first study on wearables confirmed the importance of the habit determinant and in Table 2 we build a new proposition for serious games.
Next to that we propose perceived enjoyment as determinant for successful diffusion of serious games. Finally we use the concept of information quality of Delone and McLean to address the importance of learning and feedback in serious games. Diffusion of wearables is hindered by the perception of a lack of relevance by users and a lack of relative advantage. This may enhance the perception of relevance. However, the more information is captured the more security and privacy issues arise.
Currently wearables just provide descriptive facts. From a serious gaming point of view, we can conclude that staying healthy is the most relevant factor and the perceived usefulness should address this for the user to adopt this serious game. The fun element is not elaborated yet because we think this is more the domain of professional game designers than e-health researchers.
Still fun or enjoyment is of major importance for the game. The new diffusion model for serious games can help researchers to study if a specific serious game is likely to diffuse in the target group. In Section 5. One of the key factors for discontinuing the use of wearables is the presence of errors and lack of reliability. It is expected that personal ICTs are accurate and reliable and it is left to the individual to solve problems but unfortunately most individuals do not have the knowledge, will, or time to troubleshoot and solve problems and issues that may arise with personal ICT.
Overall, the results indicated that people were neutral to positive with regards to sharing information, body data, habits, addictions, and the living environment that the wearable provided for diagnosis and statistical research.
The extent to which they are willing to share their data depended on several factors. While people believe wearables can be hacked, their opinion is divided with regards to their privacy being at stake.
From a monitoring point of view, nutrition is the hardest factor to measure. It is subjective and cannot be done in an automated way. Suggestions from the literature and interviews are to use speech recognition and imaging to monitor as easy as possible. When analysing the outcomes of the interviews, the specific reasons for why some people do not adopt or habitually use the wearable, is not very clear.
However, what became clear was that users of simple, unsophisticated models did not develop the habit of using wearables every day nor throughout the day.
The ease of use is mentioned throughout all interviews and is clearly warned for in literature as shown in the background section. Hence the title not making the serious game too serious and limit the amount of feedback. In and of itself this may not be an issue but it does mean that users may perceive the purpose of the same system differently, ranging from pure utility to pure play Berfine Koese et al.
This could help explain why some of the serious games in healthcare are not so successful on a larger scale as initially expected.
Further, it may indicate that ensuring a more consistent understanding of the purpose of the game amongst users could be significant in improving the success of the specific game with regard to its particular healthcare benefit. From games reviewed by the authors, not all of which were healthcare focused Berfine Koese et al. Our study confirms that these user conceptions from the emotional analyses seems troublesome although from a quantitative analysis there seem to be no problems for diffusion.
It is therefore important to take a qualitative perspective. In Table 2 they are shown as trust and perceived risks. We have also included a consideration for hedonic aspects; i. For example while Brooks and El-Gayar et al.
The extensive and critical use of the DSRM method in this paper justifies a generalisation of the findings in both the diffusion of wearables and the future diffusion of a serious game for Diabetes and Obesities which is the ultimate goal of this study. Hence our research results serve to build a new theoretical model that can be used to predict whether a serious game will diffuse in society and start to reach behavioural and motivational objectives.
Table 1 shows the comparison and analysis of both interview studies. It is followed by building a new model for diffusion of serious games specifically. Finally we can build upon this analysis to develop a new model for qualitative design science studies of the diffusion of serious games.
From theory Section 2. Next to perceived usefulness Davis et al. From Section 2. This determinant is specific for innovations that have to be used many times and should be validated in a future quantitative study in an extended TAM or UTAUT.
A proposition would be:. Habit has a positive and significant impact on user intention to use a serious game in healthcare. We determined an overlap between resources and resistance and took these elements together and renamed it reliability. In Appendix 2 we elaborate the content of this model toward interview questions. We start the interview with process questions to check the compatibility Rogers, of the new serious game and to get to know the interviewee.
The interview model in Appendix 2 addresses all factors found in Table 2 above. It is the dramatic impulse of childhood endeavouring to bring life into the dulness of the serious hours.
Between South and North, the probabilities of a serious , and no very distant rupture, are strong and manifest. Never then was there a moment in which there was greater need for sane and serious thought. Though the amount played for is serious , a good deal of rather bald conversation and chaff goes on. Break the boundaries of your world. Behind every hero is an embarrassing sibling. An offer you can't refuse. The Other Side of the Door. Whiplash - The road to greatness can take you to the edge.
Fear can hold you prisoner. An unforgettable fable that proves love, family and imagination conquer all.
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