A Mapping Study on Mobile Games for Patients of Chronic Diseases

Abstract

There is a growing interest of using technologies to propose solutions for healthcare issues. One of such issues is the incidence of chronic diseases, which are responsible for a considerable proportion of worldwide mortality. It is possible to prevent the development of such diseases using tools and methods that instruct the population. To achieve this, mobile games provide a powerful environment for teaching different subjects to user, without them actively knowing that they are learning new concepts. Despite the growing interest of using mobile games in healthcare, more specifically by patients with chronic diseases, in the best of our knowledge there are no studies that address the current research being published in the area. To close this gap, we carried out a systematic mapping study to synthesize an overview of the area. Five databases were searched and more than 1200 studies were analyzed and filtered. Among them, 17 met the the inclusion and exclusion criteria defined in this work. The results show that there is still room for research in this area, since the studies focus on a younger audience rather than proposing solutions for all ages. Furthermore, the number of chronic conditions being addressed is still small, obesity and diabetes are prevalent. Besides, the full capacity of game features that foster learning through games are not being employed, the majority of games proposed by the articles encompass less than half of these features.

Appendices

Appendix A

Appendix B

Reference	Game description	Genre	Platform
[13]	The ‘food quiz’ game is a simple training game designed for mobile smartphones and is to be used by young diabetics. The players have to select the correct amount of bread units based (10 to 12 gram carbohydrates in food) on the description and a photograph of the food.	Quiz	Mobile smartphones. OS not specified.
[21]	The Grocery Hunter is used by kids when accompanying their parents on shopping trips. The system provides the child with a clue about a healthy grocery store item located in the vicinity, and the child must search for this item. Once the child has found what they think is the appropriate item, they simply scan the item with the Grocery Hunter.	Puzzle	Custom mobile platform.
[8]	The players use different types of transportation, in a race to get to the goal first. The game tricks the players into unknowingly using their knowledge about insulin – fuel is food, oil/air is insulin and speed is exercise level.	Racing	Smartphones, OS not specified
[10]	Dancing game that uses wireless 3-axis accelerometers that are worn around the ankles of the players to record their movement. The mobile smartphone is used to control the game and to display graphics.	Dancing	Android
[40]	Players build their castle with a protective wall around it by entering the value of a blood sugar level (BSL) measurement for the first time. From then on, the location of each measurement will become a tower point to give more scoring points and more protection against mysterious Dark Forces. The objective of the game is to protect the castle and earn as many points as possible. Thereby, the player is forced to walk around and measure the BSL regularly.	Exergame	Web based
[23]	A exergame that strives to stimulate players to stay active. They receive rewards in the form of credits for completing a daily goal. As the players achieve daily goals, they are rewarded with extra credits and a higher level and which may also result in the character losing weight (the avatar gets slimmer). At the end of the week the remaining stored steps will be deleted and the game will start again with new daily and weekly goals.	Exergame	Android
[37]	A golf simulation game in which users have to perform two types of exercises: a swing to simulate a drive or put, and walking to the current position of the ball. A game consists of three, six or nine hole courses. Users can play against each others or play alone and try to improve their own score.	Simulation	Android
[2]	A series of different minigames that teach children healthy eating habits, some games do not involve activities and others do, such as jumping and running.	Minigames	Smartphones, OS not specified
[1]	Exergame in which obese patients compete against each other. The player with most stars wins. To collect stars users have to run in real world.	Exergame	Android
[16]	All games are basic 2D arcade games, with play mechanics that range from “Angry Birds” to “Pokemon” and “Bubble Pop.” Each game uses the gaming interface to teach about the topic of that particular game.	Minigames	Smartphones/tablets, OS not specified
[19]	A flying cow has to avoid obstacles that are encountered on the way by jumping over them. The users have to keep up with the speed of the cow during the game by moving their steps in a certain speed. They can also make the cow avoid the obstacles by jumping on the floor.	Exergame	Android
[26]	It employs a game story and the physical activity of the users with associated energy expenditure information as a motivational support for encouraging people to initiate their exercise routines. It utilizes GPS technology to keep track of the outdoor activities of the users.	Exergame	Android
[35]	Treasury Hunt Game. Treasures are hidden in everyday environments, such as parks, school or shopping centers. Different physical exercises such as walking, running, etc. are integrated into the game flow. The game will ask the user to perform a certain physical activity under certain conditions and at certain location in order to gain some scores.	Exergame	Smartphones, OS not specified
[36]	Patients act as photographers instead of fighters. More precisely, patients must detect animals based on corresponding sounds. They change the heading of their smart mobile device to locate the source of the sound and they take a picture. They win points if they successfully photographed the animal.	Simulation	iOS/ Android/ Windows Phone
[28]	In Aquamorra, the players assume the role of a young human-like character of either gender, who crash-landed their spaceship on a strange liquid planet inhabited by three competing families, the Aquamorra. The players must find a way out of this world.	Adventure	iOS/Android
[3]	The players need to help the superhero to rescue his parents. The superhero needs to eat healthy, eat balanced and eat on-time. The super hero also needs to perform the correct exercises and activities to stay healthy. The narrative then breaks several times during a day long mission to ask the child to assist the superhero and make the appropriate choices.	Interactive narrative	Portable device/Computer
[24]	HappyInu is a 3-level Android game that we developed where players adopt and care for a pet puppy over 30 days. At the end of the 30 days a dog competition takes place where the two healthiest puppies win cash rewards.	Pet-care	Android

Appendix C

Reference	Validation method
[2, 8, 16, 28, 35, 40]	No evaluation performed
[13]	Participatory design involving young people with diabetes and two dietitians, gameplay sessions with selected users and a post-test survey with open-ended questions
[21]	Usability testing consisting of observing the system usage by the participants, as well as pre and post opinion surveys from both children and parents
[10]	Evaluation containing three phases: training the users, gameplay, and a follow-up questionnaire composed of a combination of Likert scale and short response questions
[23]	The participants had to play the game for a while and, afterwards, complete an online post-survey
[37]	Participants were given an Android phone and a short explanation of the application and were asked to complete the virtual golf course. Then, they had to fill out a survey (Likert scale) investigating usability, enjoyment, effectiveness, and realism
[1]	The users were asked to play the game. Then, a post-survey to assess the usability and mobility of the game was employed
[19]	Children were invited to participate in gaming sessions. A quantitative evaluation based on the heart rate variations was employed to assess the physical stimulation during gameplay. Finally, to evaluate the quality of playing experience, the users answered 5 questions at the end of the gaming sessions
[26]	Evaluation was divided in two parts. Firstly, the performance of the application is measured by precision, recall, accuracy, and f-measure, respectively. Then, the satisfaction of the users is measured using post-surveys
[36]	A user study was conducted were the users had to play 3 levels with all mobile operating systems. Then, the authors applied a linear mixed effect model to evaluate the differences of these platforms. Finally, an ANOVA was calculated with respect to the duration to take a picture and angle offset of the target
[3]	T1: Pre-survey collecting basic demographic data for both control (children/parents consuming printed education materials) and intervention (children/parents playing the game) groups. T2: Immediate post-intervention survey to assess the perceived value of the game to the parents among the intervention group. T3: After 2 months, participants of both groups were asked to complete the same questionnaires from T1 and T2
[24]	Pre-survey to collect baseline data, then they were asked to play the game for 3 weeks and, afterwards, the participants completed a post-survey rating the game in terms of how enjoyable they found it and its suitability for food tracking. Furthermore, they provided open-ended responses about their experiences and participated in a group interview