The Use of digital games to enhance the physical exercise activity of the elderly : a case of Finland

According to the World Health Organization (WHO), population ageing is a global phenomenon, which brings both challenges and opportunities for society. The current longer expected lifespan can create opportunities for the elderly to contribute in many ways to their families and communities. However, it greatly depends on their quality of life, which is affected by many factors, including physical and functional health, social well-being, and cognitive abilities. The WHO (2012) states that physical health is one of the indicators for the elderly’s quality of life, and it declines with increasing age. Participation in regular physical exercises can help the elderly improve their physical and mental health, and this has been aided by the use of modern technologies to promote the elderly’s physical and functional health. Of these latest technologies, digital games have shown promise to improve and enhance the elderly’s physical activities through fun and engaging gameplay. The literature highlights that some commercial games in the market (e.g. Microsoft Kinect- Sports and Nintendo Wii Sports games) have the potential to improve the elderly’s physical health such as gait, balance, and fall prevention. However, researchers argue that these commercial games are not designed specifically for the elderly and their physical exercise activities. They state that most commercial games are not user-friendly for the elderly whose functional and physical abilities are limited due to their advanced years. The literature points out that more studies need to be undertaken to understand the usability and usefulness of digital games for physical exercise activities so that game designers can create elderly-friendly digital games in the future. In Finland, the government has been focusing on promoting healthy ageing and increasing home care services for the elderly. In recent years, Finnish researchers have used digital games to promote older Finns’ healthy and active ageing. The existing literature, whilst showing the potential of digital games for elderly Finns’ physical health, also acknowledges further research is needed particularly in the context of Finland. Thus, in this study, we aimed at investigating digital games to specifically assess their applications for older Finns’ physical activities, focusing on the quality of users’ experiences, and their reported ease of use and perceived usefulness. We used the mixed methods approach, which applies both qualitative and quantitative research methods. The study design included four stages: requirements gathering, analysis and design, prototyping, and evaluation. Firstly, we conducted pre-studies to elicit users’ requirements. This was followed by the analysis of the resulting data to identify trends and patterns, which fuelled ideas in the brainstorming game design and development phases. The final product was a digital game-based physical exercise called the Skiing Game. We then evaluated the Skiing Game in Finland with 21 elderly Finns (M=7, F=14, Average Age =76). By using questionnaires, observation, and interviews, we investigated user experiences, focusing on the game’s usability, and usefulness for enhancing the physical activity and wellbeing of the elderly. We also conducted a comparative test of the Skiing Game in Japan with 24 elderly Japanese participants (M=12, F=12, Average Age = 72) to further understand non-Finnish elderly users’ experiences. The findings from the usability study of the Skiing Game in Finland demonstrated that elderly Finns had a positive experience in the gameplay, and their motivation was noticeably high. It also confirmed that elderly Finns have a genuine interest in digital game-based exercises and strong intentions to play digital games as a form of physical exercise in the future. Although prior to the study most of them had negative views and misconceptions about digital games, after the gameplay their attitudes were decidedly positive. They acknowledged that whilst playing digital games could be an alternative way of exercising for them their use would primarily be when they don’t have access to their usual non-digital physical exercise. The Japanese usability of the Skiing Game showed that the elderly Japanese people also had positive user experiences in playing digital games, and also intend to use them in the future. Similarly, after playing the game they reported that their attitudes towards digital games become positive, and indicated playing digital games could be an alternative way of exercising. Although the comparison of the two studies suggests that the elderly Finns had relatively more positive experiences whilst playing the Skiing Game, compared to their Japanese counterparts, in general, both groups had a positive experience in the gameplay and showed interest in digital games as an alternative exercise. Based on the usability lessons learned from these two studies, recommendations for practitioners and designers regarding improvements in game design and development are made in this report. Implementing these modifications into future designs and further development of digital games for the elderly will improve their commercial viability and user uptake. The findings from this study can provide valuable insights, particularly for Finnish policymakers and healthcare practitioners who are keen to introduce digital games into the aged-care sector in Finland. The studies have also provided valuable insights into the optimal methods for introducing Finnish digital games to international markets, in particular, digital games tailored specifically for the physical exercise needs and motivations of the elderly. By taking into consideration the limitations of the study, we provide our future studies and further improvements of the game to be conducted

Understanding personal and contextual factors to increase motivation in gamified systems

Gamification, the use of game elements in non-game contexts, has been shown to help people reaching their goals, affect people's behavior and enhance the users' experience within interactive systems. However, past research has shown that gamification is not always successful. In fact, literature reviews revealed that almost half of the interventions were only partially successful or even unsuccessful. Therefore, understanding the factors that have an influence on psychological measures and behavioral outcomes of gamified systems is much in need. In this thesis, we contribute to this by considering the context in which gamified systems are applied and by understanding personal factors of users interacting with the system. Guided by Self-Determination Theory, a major theory on human motivation, we investigate gamification and its effects on motivation and behavior in behavior change contexts, provide insights on contextual factors, contribute knowledge on the effect of personal factors on both the perception and effectiveness of gamification elements and lay out ways of utilizing this knowledge to implement personalized gamified systems. Our contribution is manifold: We show that gamification affects motivation through need satisfaction and by evoking positive affective experiences, ultimately leading to changes in people's behavior. Moreover, we show that age, the intention to change behavior, and Hexad user types play an important role in explaining interpersonal differences in the perception of gamification elements and that tailoring gamified systems based on these personal factors has beneficial effects on both psychological and behavioral outcomes. Lastly, we show that Hexad user types can be partially predicted by smartphone data and interaction behavior in gamified systems and that they can be assessed in a gameful way, allowing to utilize our findings in gamification practice. Finally, we propose a conceptual framework to increase motivation in gamified systems, which builds upon our findings and outlines the importance of considering both contextual and personal factors. Based on these contributions, this thesis advances the field of gamification by contributing knowledge to the open questions of how and why gamification works and which factors play a role in this regard.Gamification, die Nutzung von Spielelementen in spielfremden Kontexten, kann nachweislich Menschen helfen, ihre Ziele zu erreichen, das Verhalten von Menschen zu beeinflussen und die Erfahrung der User in interaktiven Systemen zu verbessern. Allerdings hat die bisherige Forschung gezeigt, dass Gamification nicht immer erfolgreich ist. So haben Literaturübersichten ergeben, dass fast die Hälfte der Interventionen nur teilweise erfolgreich oder sogar erfolglos waren. Daher besteht ein großer Bedarf, die Faktoren zu verstehen, die einen Einfluss auf psychologische Maße sowie auf das Verhalten von Usern in gamifizierten Systemen haben. In dieser Arbeit tragen wir dazu bei, indem wir den Kontext, in dem gamifizierte Systeme eingesetzt werden, betrachten und persönliche Faktoren von Usern, die mit dem System interagieren, verstehen. Geleitet von der Selbstbestimmungstheorie, einer der wichtigsten Theorien zur menschlichen Motivation, untersuchen wir Gamification und dessen Auswirkungen auf Motivation und Verhalten in Kontexten zur Verhaltensänderung. Wir liefern Erkenntnisse über kontextuelle Faktoren, tragen Wissen über den Einfluss persönlicher Faktoren auf die Wahrnehmung und Effektivität von Gamification-Elementen bei und bieten Möglichkeiten, dieses Wissen für die Implementierung personalisierter gamifizierter Systeme zu nutzen. Unser Beitrag ist mannigfaltig: Wir zeigen, dass Gamification die Motivation durch Bedürfnisbefriedigung und durch das Hervorrufen positiver affektiver Erfahrungen beeinflusst, was letztlich zu Verhaltensänderungen führen kann. Darüber hinaus zeigen wir, dass das Alter, die Absicht, das Verhalten zu ändern, und Hexad-Usertypen eine wichtige Rolle bei der Erklärung von interpersonellen Unterschieden in der Wahrnehmung von Gamification-Elementen spielen. Ebenso zeigen unsere Resultate dass die Anpassung von gamifizierten Systemen auf Basis dieser persönlichen Faktoren positive Auswirkungen auf psychologische und verhaltensbezogene Ergebnisse hat. Letztlich zeigen wir, dass Hexad-Usertypen teilweise durch Smartphone-Daten und Interaktionsverhalten in gamifizierten Systemen vorhergesagt werden können und dass sie auf spielerische Art und Weise erhoben werden können. Dies ermöglicht, unsere Erkenntnisse in der Gamification-Praxis zu nutzen. Auf Basis dieser Ergebnisse schlagen wir ein konzeptuelles Framework zur Steigerung der Motivation in gamifizierten Systemen vor, das die Wichtigkeit der Berücksichtigung sowohl kontextueller als auch persönlicher Faktoren hervorhebt. Diese Erkenntnisse bereichern das Forschungsfeld Gamification, indem sie Wissen zu den offenen Fragen, wie und warum Gamification funktioniert und welche Faktoren in diesem Zusammenhang eine Rolle spielen, beitragen

HEALTHY, ACTIVE AND CONNECTED: TOWARDS DESIGNING AN AGE-FRIENDLY DIGITAL NEIGHBORHOOD PLATFORM

Due to declining fertility rates and rising life expectancy, the world’s population is ageing at an unprecedented pace. This demographic change is expected to exert pressure on social security as well as healthcare systems and poses the risk of social exclusion of the elderly. As urban areas are home to the majority of the global elderly population, they are disproportionately affected by this development. Cities have begun responding with strategies ranging from policy and regulation reform to investments in innovative healthcare technologies with the goal of becoming “age-friendly”. Enabling the elderly to live a socially active, healthy and self-determined lifestyle past retirement are among the prime objectives for alleviating the challenges of an ageing society. With increasing urbanization, human, technological and infrastructural resources of urban contexts or neighborhoods have presented themselves as important determinants of elderly well-being. We propose that an age-friendly digital neighborhood platform can activate and leverage these re-sources to the benefit of the elderly population, contributing to the mitigation of the challenges of an ageing society. Following a design science research approach, we develop design principles for such an age-friendly digital neighborhood platform and evaluate a prototypical instantiation in two case neighborhoods in a German metropolitan area

GAMIFICATION BASED ASSESSMENT: A TEST ANXIETY REDUCTION THROUGH GAME ELEMENTS IN QUIZIZZ PLATFORM

Test anxiety always makes students afraid of doing the test because they probably think that they will fail. To overcome the problem, the teacher then used gamification based assessment. Furthermore, the study investigates the category of students test anxiety, students' attitudes toward Quizizz and the students' preference toward the elements of game in Quizizz. This study is a case study which the data were collected by using observation, interview, and questionnaires. The participants of this study were 14 students in an English course in Solo. The sampling used by the researcher was purposive sampling. The results of this study showed the category of students test anxiety considered moderately high, the students' attitude toward Quizizz in reducing test anxiety also considered high (M= 3.94) and the kinds of elements of game which students prefer most were Points (M= 4.357), Test report (M= 3.929), Leader board (M=3.714), Time restriction (M=3.357), Profile (M= 3.429) and Meme (M= 3.357). The implication of this study is Quizizz successfully reduce test anxiety because of the use of game elements in that application. Thus, it is a good option for teachers to use Quizizz on the exam

Meta-Analysis For Comparing Effect Between Game-Based Learning Versus Gamification Utilized In Nutrition Education

The prevalence of obesity tripled from 1975 to 2016 and was declared as a global epidemic by the World Health Organization (WHO) in 1997 (Haththotuwa et al., 2020; Controlling the global obesity epidemic, 2022). Nutrition education that involves knowledge and behavioral change is one major component addressing the problem ( Controlling the global obesity epidemic, 2022). Therefore, the effectiveness of each learning session is essential (Sharifirad et al., 2013). Thus, many nutrition educators have used gamified nutrition education to improve teaching effectiveness to increase healthy behavior or knowledge (Chow et al., 2020.; Munguba et al., 2008; Azevedo et al., 2019). Two approaches were often used for gamified learning: gamification and GBL (GBL; Browne et al., 2014; Johnson et al., 2016; Chow et al., 2020). Gamification applies a game mechanism to non-game content, while GBL or serious gaming involves a game that was built to achieve educational goals (De Freitas, 2006; Johnson et al., 2016). Despite many positive outcomes promoted by gamified education as a whole (Chow et al., 2020; Hamari et al., 2014), there is disagreement among researchers and professionals regarding how games affect education. This study aims to identify and analyze research literature on the effects of active game, gamification and GBL applied to nutrition knowledge and behavior. The researcher performed a network meta-analysis with three sub-constructs. First, searching journal articles that addressed nutrition education implied an intervention consolidated educational strategies into food choice knowledge, fruit and vegetable consumption, and physical activity to a non-medical background population. Then, the studies were compared on the average effect of treatment indirectly through the control group. Results indicated there were plenty of studies that investigated the effect of gamification or GBL to nutrition education. Out of three focused outcomes: food choice knowledge, fruit and vegetable consumption, and physical activity, only studies focusing on physical activity were able to produce measurable differences by comparing hours per week spent performing physical activity. Comparison of the treatment result showed that gamification had the greatest improvement in facilitating physical activity, but it was non-significant. This suggests that utilizing gamification across the globe would be the more successful intervention strategy, but would require improved heterogeneity of measurements for food knowledge and fruit and vegetable consumption in order to achieve consistent measurable results for comparison

Potential and effects of personalizing gameful fitness applications using behavior change intentions and Hexad user types

Personalizing gameful applications is essential to account for interpersonal differences in the perception of gameful design elements. Considering that an increasing number of people lead sedentary lifestyles, using personalized gameful applications to encourage physical activity is a particularly relevant domain. In this article, we investigate behavior change intentions and Hexad user types as factors to personalize gameful fitness applications. We first explored the potential of these two factors by analyzing differences in the perceived persuasiveness of gameful design elements using a storyboards-based online study (N=178). Our results show several significant effects regarding both factors and thus support the usefulness of them in explaining perceptual differences. Based on these findings, we implemented “Endless Universe,” a personalized gameful application encouraging physical activity on a treadmill. We used the system in a laboratory study (N=20) to study actual effects of personalization on the users’ performance, enjoyment and affective experiences. While we did not find effects on the immediate performance of users, positive effects on user experience-related measures were found. The results of this study support the relevance of behavior change intentions and Hexad user types for personalizing gameful fitness systems further

Gamified Solutions in Healthcare - Testing Rehabilitation Games in Finland and Asia

This paper presents a comprehensive summary of the Gamified Solutions in Healthcare (GSH) research project, which is a joint research project between Turku University of Applied Sciences and the University of Turku. The goal of the project is to promote exercise, social inclusiveness and enhance quality of life, aiming at developing new services and effective activity solutions for the elderly through gamification. During the research project elderly people were included in the development and testing of games so that they could be used for more than just entertainment purposes. According to all of our tests elderly enjoy playing exergames, and digital games can be an effective way to enhance the quality of life of the elderly. In the case studies it was observed that the players where motivated while playing but motivation should also be maintained throughout the gameplay. The elderly gave overall positive feedback for the idea of using digital activity games for exercising. </div