Levels in Games for Health.

There is a time-honored procedure in games for pure entertainment wherein games challenge their players by offering successfully higher levels of difficulty. An eminent researcher proposed that player engagement and enjoyment require the player being constantly challenged, but at a level she or he can handle. A game's difficulty levels enable the player to face more difficult challenges as she or he builds gameplaying skills. Although levels work in games for entertainment, it is not clear how effective or important levels are in games for health, or how they are designed. We invited several accomplished games for health designers and researchers to discuss levels.

Using What's Learned in the Game for Use in Real Life.

A player can learn many things from playing a game for health. Some of these learnings were deliberately designed for the player to use in his or her real life, outside of any game. The effective ways to enable players to generalize what they learn in the game to their real lives (and thereby benefit from playing the game) are not clear. We have convened a group of expert health game designers and researchers to discuss this important issue.

Business Models for Successfully Maintaining Games for Health.

Videogames for health provide innovative, exciting, and possibly highly effective new media for helping players change their behaviors or otherwise benefit their health. Getting the right videogames into the hands of players who can benefit most in a way that pays for the continued innovation and creation of such games is a current challenge. Entertainment videogame companies, which create games primarily to enhance players' enjoyment, have used the general business marketplace (e.g., online stores, walk-in stores, app stores) to deliver their products directly to consumers and earn enough capital to invest in making new products. No one believes, however, that enough kids or adults would use the general business marketplace to purchase games for health in sufficient volume to provide the down payment for the innovation and creation of new games for health. A successful business model is critical to the financial future of games for health. We asked members of our Editorial Board who are in health-related companies (Fikry Isaac, MD, MPH), in several game development companies (Chris Ashford, Ron Goldman, David J. Lenihan, Brent Poole, and Richard Buday, FAIA), and the head of the Games for Health Europe Foundation (Jurriaan van Rijswijk, MSc) to address questions in a roundtable about the current and possible future business models for games for health.

Videogame Mechanics in Games for Health.

Game mechanics have been identified as "methods invoked by agents for interacting with the game world."(1) They are elements of game play that provide a primary source of interactivity and structure how videogames proceed. Many kinds of game mechanics have been generated. Some provide fun or enjoyment, others may provide excitement or even suspense (i.e., emotional aspects of game play), whereas some are guided by principles of behavior change theory. Game mechanics that succeed in off-the-shelf entertainment videogames, however, may not work in serious games, such as games for health (G4H). Although game mechanics are key to a serious videogame's success, maintaining a balance between the serious intent of the game while keeping it fun, there has been little attention to game mechanics in the academic G4H literature. Several eminent games for health developers (academics and nonacademics) were asked to share their experiences in regard to game mechanics in the serious videogames they have developed.

Stories in Games for Health: More Pros or Cons?

There has been a debate about whether entertainment videogames should incorporate story or narrative. A concern has been whether story cut scenes break game immersion, and thereby minimize the fun of gameplay. Alternatively, games for health (G4H) have an agenda that goes beyond just having fun. The possible role of story in G4H has not been thoroughly addressed. We have assembled a group of experts who have worked with stories in G4H, and asked some pointed questions.

A European Profile of Games for Health.

October is time for the Games for Health Europe meeting in Amsterdam, The Netherlands. Games for Health Journal would like to highlight exciting developments in games for health in Europe by asking European members of our Editorial Board to comment on what developments they see.

Effective Feedback Procedures in Games for Health.

Feedback on game performance can be provided in many ways (e.g., cumulative points on game achievements, points on selected aspects of game play, biofeedback, brief statements offered during gameplay on choices made, verbal feedback at end of gameplay on overall performance, etc.). Feedback could be used motivationally to maintain player interest and involvement, informationally to guide the player in more effective choices, to build player confidence, and for a variety of other purposes. Although diverse feedback types and purposes are possible, some are more likely to be useful and effective. We have contacted several accomplished game designers and game researchers to obtain their insights into issues in feedback in Games for Health Journal.