Change your lifestyle or your game is over The design of a serious game for Diabetes Harmen Nauta, Ton AM Spil, University of Twente, The Netherlands University of Twente, The Netherlands a.a.m.spil@utwente.nl harmennauta@gmail.com Abstract—Diabetes mellitus is one of the chronic game elements, appeared to be an effective diseases that leads to great concerns worldwide. approach. This study uses a model of lifestyle change to b. What distinction can be made in the enhance serious gaming in healthcare. Seven population of diabetes type 2 patients healthcare providers were interviewed in a pre- regarding to the achievement of lifestyle study, Six patients tested the prototype in a focus change and what does this mean for a group and nine patients co-operated in an serious game? evaluation. The theoretical contributions show that it is difficult to design a single game that The division based on the motivation to change meets all users needs. One solution is to design a lifestyle, here the non-intenders, intenders and modular application were adaptations can be actors, was valuable in characterization of made in order to meet the patient specific needs, different groups in the diabetes type 2 population. in the presence of the play, meaning and reality From the findings it can be concluded that the components, but also in functionality. Different major group of the diabetes population are functionality is needed for non-intenders (play), intenders and consequently are the main target intenders (meaning) and actors (reality). Practical group for a serious game. However, for the non- contributions of this study give the health care intenders and actors serious gaming also has providers more insight in the daily activities and enough potential to support in the change or personal measurements of the patients and it improvement of lifestyle. improves the possibilities for self-management for the patients themselves. c. What is serious gaming in health care a. Which behavior methods are important to and which game components should induce health behavior change and should be included in order to design a be included in a serious game? serious game? The behavior methods ´education and skills’, Serious gaming in healthcare needs to add a fun ‘goal setting and action planning’, ‘self- factor in the education or performance of health monitoring´, ‘reinforcements’ and ´observational related task and is divided in health professional- learning´, as presented in the model of lifestyle and patient specific games. In the category of change and tested by diabetes type 2 patients, patient-specific games, a serious game to educate resulted to be important to induce a healthy and coach a healthy lifestyle can include lifestyle. Furthermore in the design of a serious properties of the following type of games: game, the inclusion of these methods as potential education games, exergames and control games. 71 In order to design a serious game, the inclusion of care providers more insight in the daily activities the game components play, meaning and reality is and personal measurements of the patients and it important. However, in the actual design of a improves the possibilities for self-management. game, there are always tensions to what extent This results in more directed coaching and each of the components should be implemented. advises, also in between the quarterly controls. This is especially dependent on the target group, The intensity of use will differ for each group of and what the actual meaning is of the game and patients. A patient can use it intensively in the from the game elements containing it. first period after diagnosis, but when a healthy lifestyle is reached it will be used more like a Main Question - How can a serious game reference. For the patients who are often be designed for type 2 diabetes patients monitoring their personal measurements, the that both educates a healthy lifestyle and application could be used even on daily basis. personally coaches during daily life? - In summary, the use of serious gaming to educate and coach a healthy lifestyle in daily life is a Based on this study it can be concluded that in the promising approach in the optimization of the design of a serious game to enhance lifestyle, the diabetes care, which will be increasingly use of the model of lifestyle change was very important in the coming years. The details of the valuable. application should however still be further Regarding to the actual design of a serious game investigated. to educate and coach a healthy lifestyle, it can be concluded that the most important game elements Keywords: Serious gaming; lifestyle change; are ´education and skills’, ‘goal setting and action diabetes type 2; E-health. planning’, ‘self-monitoring´, ‘reinforcements’ and ´observational learning. The extent to which the game components play, meaning and reality ACKNOWLEDGMENT should be applied in the different game elements, We thank Health @ Home BV for their support. will however differ per group of patients, defined in non-intenders, intenders and actors. While the inclusion of the play component in all game elements can be very valuable to the non- intenders to improve intrinsic motivation to change, for the intenders and actors especially in education it results to have an added value. In the other game elements the play component could generate an extra motivation, but this is individually dependent. In general this would mean it is difficult to design a single game that meets all users’ needs. However, a solution is to design a modular application were adoptions can be made in order to meet the patient specific needs, in the presence of the game components, but also in functionality. A serious game as contemplated in this study can be an added value in the current provision of care, as it is one application that provides all tools in the support of reaching a healthy life style. It gives the health 72