JMIR Publications

ABSTRACT

Background:

The idea of using serious games to effectuate better outcomes in healthcare has gained significant traction among a growing community of researchers, developers and healthcare professionals. Many now recognize the importance of creating evidence-based games that are purposefully designed to address relevant challenges faced by end users. To date, no regulatory resources have been established to guide the development of serious games for health (SGH). Developers must therefore look elsewhere for guidance. Although a more robust level of evidence exists in the research literature, it is not structured, nor is there any clear consensus. Developers currently use a variety of approaches and methodologies. The establishment of a well-defined framework that represents the consensus views of the SGH research community would help developers improve the efficiency of internal development processes, as well as chances of success. A consensus framework would also benefit the wider SGH research community by enhancing the credibility of SGH and providing quality evidence of their effectiveness.

Objective:

This research aims first, to identify and evaluate the requirements, recommendations and guidelines proposed by the SGH research community in the research literature, and second, to develop a consensus framework that can guide developers in the development of evidence-based SGH.

Methods:

A critical review of the literature was performed in Nov-Dec 2016. A three-step search strategy and a predefined set of inclusion criteria were used to identify relevant articles in PubMed, ScienceDirect, and Google Scholar. A supplemental search of publications from regulatory authorities was also conducted to capture requirements of these specific stakeholders. Three researchers independently evaluated the identified articles. The associated evidence was coded and categorized for analysis and evaluation.

Results:

Our review identified 4 categories of high-level requirements as well as 19 low-level requirements, suggested by the SGH community. These advocate a methodological approach that is multi-disciplinary, iterative and participatory. Based on the requirements identified, we propose a framework for developing theory-driven evidence-based SGH. It consists of 5 distinct stages that are informed by various stakeholders and focusses on building strong scientific and design foundations that inform and guide the creative and technical development. It includes qualitative trials to evaluate whether the SGH achieves the intended outcomes, as well as efforts to disseminate trial findings and follow-up monitoring after the SGH is rolled out for use.

Conclusions:

Review resulted in the formulation of a framework for developing theory-driven, evidence-based SGH that represents many of the requirements set out by SGH stakeholders in the literature. The framework covers all aspects of the development process (scientific, technological and design) and is transparently described in sufficient detail to allow developers to implement it in a wide variety of projects, irrespective of discipline, healthcare segments or focus.