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Is Participatory Design Associated with the Effectiveness of Serious Digital Games for Healthy Lifestyle Promotion? A Meta-Analysis

DeSmet, Ann, Thompson, Debbe, Baranowski, Tom, Palmeira, Antonio, Verloigne, Maïté, De Bourdeaudhuij, Ilse
Journal of Medical Internet Research 2016 v.18 no.4 pp. e94
Internet, aesthetics, behavior change, databases, games, lifestyle, meta-analysis, randomized clinical trials, self-efficacy
Serious digital games can be effective at changing healthy lifestyles, but large differences in their effectiveness exist. The extent of user involvement in game design may contribute to game effectiveness by creating a better fit with user preferences. Participatory design (PD), which represents active user involvement as informant (ie, users are asked for input and feedback) or codesigner (ie, users as equal partners in the design) early on and throughout the game development, may be associated with higher game effectiveness, as opposed to no user involvement or limited user involvement. This paper reports the results of a meta-analysis examining the moderating role of PD in the effectiveness of serious digital games for healthy lifestyle promotion. Four databases were searched for peer-reviewed papers in English that were published or in press before October 2014, using a (group-) randomized controlled trial design. Effectiveness data were derived from another meta-analysis assessing the role of behavior change techniques and game features in serious game effectiveness. A total of 58 games evaluated in 61 studies were included. As previously reported, serious digital games had positive effects on healthy lifestyles and their determinants. Unexpectedly, PD (g=0.075, 95% CI 0.017 to 0.133) throughout game development was related to lower game effectiveness on behavior (Q=6.74, P < .05) than when users were only involved as testers (g=0.520, 95% CI 0.150 to 0.890, P < .01). Games developed with PD (g=0.171, 95% CI 0.061 to 0.281, P < .01) were also related to lower game effectiveness on self-efficacy (Q=7.83, P < .05) than when users were not involved in game design (g=0.384, 95% CI 0.283 to 0.485, P < .001). Some differences were noted depending on age group, publication year of the study, and on the specific role in PD (ie, informant or codesigner), and depending on the game design element. Games developed with PD were more effective in changing behavioral determinants when they included users in design elements on game dynamics (beta=.215, 95% CI .075 to .356, P < .01) and, more specifically, as an informant (beta=.235, 95% CI .079 to .329, P < .01). Involving users as informants in PD to create game levels was also related to higher game effectiveness (Q=7.02, P < .01). Codesign was related to higher effectiveness when used to create the game challenge (Q=11.23, P < .01), but to lower game effectiveness when used to create characters (Q=4.36, P < .05) and the game world (Q=3.99, P < .05). The findings do not support higher effectiveness of games developed with PD. However, significant differences existed among PD games. More support was found for informant roles than for codesign roles. When PD was applied to game dynamics, levels, and game challenge, this was associated with higher effectiveness than when it was applied to game aesthetics. Since user involvement may have an important influence on reach, adoption, and implementation of the intervention, further research and design efforts are needed to enhance effectiveness of serious games developed with PD.