By Kate Metropolis
Barbara Chamberlin wants to improve the way health games are developed and used.
She began her work in serious games more than two decades ago, collaborating on games to prevent tobacco use in teens; to improve nutrition, with versions in English, Spanish and Navajo; and to teach about the role fire plays in the forest ecosystem. Despite a track record in designing games in a number of educational areas, she’s frequently encountered skepticism about games from funding agencies and reviewers. Chamberlin, who holds a Ph.D. in instructional technology from the University of Virginia and directs research in the Learning Games Lab at New Mexico State University, recalls receiving “horrible reviews” a few years ago when she and her colleagues proposed to investigate benefits and risks of exergames (that require physical exertion to play): one grant review panel member refused even to consider the possibility that video games could increase physical activity. However, Chamberlin has now garnered some highly favorable reviews from a variety of funding sources. For example, she is currently the principal investigator for a $1.5 million US Department of Agriculture grant that focuses on the use of exergames to help reduce obesity among at-risk youth. She collaborates with professional game developers and obesity-prevention researchers on this high-profile project, and yet whenever she writes a new grant proposal she still worries that the approach of using electronic games to address the obesity problem will be thwarted by reviewers who consider screen time anathema. “At every point in this work,” she says, “we find someone who says, ‘Wait—aren’t games part of the problem?’ Whereas research has shown that games can really be an effective part of the solution.”
There are ways to convince the doubters, Chamberlin believes. Just as good maps depend on the skills of both the cartographers and the explorers who measure the terrain, good serious games draw on the expertise of both game developers and researchers. Chamberlin herself has experience in both fields: she has helped develop health games on tobacco use, nutrition, and food safety, and she has helped bring research findings on the benefits and risks of serious games to the attention of decision makers in government and the private sector. In 2008, for example, she presented data to the Department of Agriculture’s Children, Youth, and Families at Risk Program showing that active games can offer benefits including increased energy expenditure, improved social skills and academic performance, and reduced school absenteeism. Using active games is often more viable for low-income and at-risk kids than the more traditional ways of exercising that require expensive equipment, safe outdoor playing areas, or organized teams. The “Exergames Unlocked” web site, created with her team at NMSU, documents effective uses of games and helps program leaders identify best practices (and best games) in using exergames in their programs.
Chamberlin’s own career exemplifies the concept of serious entertainment. For several years she was a stand-up comic—good enough to be an occasional headliner at smaller comedy clubs and “one night” shows. When all the extended travel didn’t leave enough time for creating educational games, she weighed the two choices and games won out. Speaking at conferences and dinners, though, she regularly gets to walk a little way down the road not taken. “I really enjoy telling stories that make people laugh, then think,” she says. Deriding human behavior, though, is an avenue to laughter that Chamberlin treads warily. She removed a bit from her stand-up routine about the side effects that appear in pharmaceutical ads, because she feared that she might inadvertently dissuade someone in the audience from taking a vital drug, if it seemed that Chamberlin was ridiculing it or the people who take it. “As a stand-up comic, I’m being too sensitive… most comics would have run with the bit,” she says. “As an educator, it is important to think about how your words and approach could impact every single user.”
In Chamberlin’s view, research ought to be central to the development of health games. Science should support both the information a game is intended to convey and the behavior change the game is intended to instill. Developers need to validate their assumptions about what’s known and what should be done.
Once there’s scientific support for the content and format of a game, Chamberlin says, it’s important to define the target audience, how and where the game will be played, and what players should know or do as a result of playing. It’s crucial to understand, she stresses, how this content is currently taught in traditional ways and why that process fails—a particularly vexing question in the field of health. “Too often, games address only knowledge change, but that may not be enough. I understand exactly how many calories I should ingest and that I need to consume more calcium, but I’m still not eating like I should,” she says. “My poor behavior in these areas isn’t from a lack of knowledge. What health games often do is simply reward a player for knowing something, when what they ought to do is provide motivation and strategies for behavior change.”
A frequently ignored question in health game assessment, Chamberlin says, is the impact of how and where a game is played. “We are used to thinking of games in an environment where the player sits, plays the game, and then leaves. How do social and multiplayer games change that? And, how can we use games that are played a few minutes at a time, but over a longer period, such as those on Facebook or on mobile phone platforms?”
Chamberlin also thinks about how to design and implement health games for a wider spectrum of players. Serious games aren’t just for young people, she believes. “Older adults—who have traditionally been non-gamers—are being exposed to games on platforms like Facebook or the Wii and are starting to realize how enjoyable they are,” she says. She also sees great potential for games aimed at health care professionals and not just patients: games that could help health care administrators improve discharge paperwork, for example, or that could give hospital staff opportunities to rehearse the procedures they will use when dealing with large numbers of patients during disasters and epidemics, or that could help nurses provide information on diet and nutrition to patients who speak another language.
Chamberlin is enthusiastic about the new technologies and game-playing environments that could deliver health games to players in a wide range of settings. “Tablet computers, mobile phones with larger screens, and more portable laptops give us the power to create more immersive games and to make them more available no matter where the individual happens to be. We’ve talked about games for those in the hospital to play while waiting in emergency rooms, pre-op, post-op.” When a patient who has nothing else to do can easily play a game on a mobile or portable device, she points out, there’s an opportunity—which would normally be wasted—for learning.
The reason for resistance to serious games as effective tools for improving health and health care might simply be an accident of history: if serious games had come first—and games purely for entertainment second—no one would raise an eyebrow at the idea of games as powerful health interventions. Recently, however, Chamberlin has found reasons to become more hopeful about the acceptance of serious games. “There have been some really great efforts in government-funded research and from the grantees of the Robert Wood Johnson Foundation’s national program, Health Games Research,” she says. “I’m optimistic that support for health games, and support for research that can help improve their design and effectiveness, will continue to grow as we see measurable improvements in learning and health behavior with game-based interventions. Finally, we are facing a tipping point.”