Accepted for/Published in: JMIR Serious Games
Date Submitted: Jan 2, 2023
Date Accepted: Jan 24, 2023
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
The Design Preferences for a Serious Game-based Cognitive Assessment of Older People in Prison: Thematic Analysis
ABSTRACT
Background:
Serious games have the potential to transform the field of cognitive assessment. The application of a serious game-based assessment is particularly exciting in the context of prison where interventions are urgently needed to address the rapid increase of currently incarcerated older people globally, and the heightened risks of dementia and cognitive decline present in this population. Game-based assessment are assumed to be fun, engaging and suitable alternatives to traditional cognitive testing, but these assumptions remain mostly untested in older people. This is especially true for older people in prison, whose preferences and needs are seldom heard and may deviate from those previously captured in research on cognition and serious games.
Objective:
The purpose of this study was to understand the design preferences of older people in prison for a cognitive game-based assessment.
Methods:
This study used reflexive thematic analysis, underpinned by critical realism, and applied the technique of abduction. Four focus groups with a total of twenty people (n=20) were conducted with older people (aged 50+, 45+ for Aboriginal people) across three distinct prison environments in Australia.
Results:
Self-Determination Theory (SDT) was used as a theoretical foundation to interpret the results. Three themes were generated. (#1) Goldilocks: getting gameplay difficulty ‘just right’ through optimal challenge. The first theme emphasises the participants’ collective desire for an individualised optimal level of difficulty in serious gameplay. (#2) Avoiding childish graphics: gimmicky gameplay can be condescending. The second theme raises the importance of avoiding immature and childlike gameplay features, as some older end users in prison felt these can be condescending. (#3) A balanced diet: meaningful choice and variety keeps game-based assessments fun. The third theme highlights the strong user preference for meaningful choice and variety in any serious game-based cognitive assessment to maximise in-game autonomy.
Conclusions:
The collection of these themes provides novel insights into key game design preferences for marginalised older people. Clinical Trial: N/A
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