Exploring in-game rewards in the diaquarium. A serious game for children with type 1 diabetes mellitus

Abstract

Digital games do not only serve entertainment purposes, but can also benefit as useful tools for learning. Games that have an explicit and carefully thought-out educational intention has appeared as very productive within health care, and have been used more frequently as part of treatment among children with Type 1 Diabetes Mellitus. Insulin-depended diabetes has no known cure at the present time, hence, individuals living with the disease are fully depended on their self-treatment competence to stay healthy throughout a lifetime. For the last couple of decades, serious games have been used to enhance knowledge and awareness regarding Diabetes Mellitus among children living with the disease, as serious games are known to be both educational and entertaining. Some of these games are the Diabetic Dog Game, Carb Counting with Lenny, and Ketones Attack. When developing serious games, the main goal is to utilize game mechanisms so that users decides to lengthen their playtime, complete levels within the game, and thereby gain progression and intended learning with regard to disease management. One major concern when developing games for health is, therefore, the possibility of users who withdraws from the game before completed. A game, with a descending popularity and users quitting gameplay early, fails to provide medical education to patients and is, in that perception, useless. For that reason, it was found significant to consider motivational game elements, such as in-game rewards, when designing serious games. This thesis identifies several reinforcement mechanisms within digital games and explores how they can be applied in an invented serious game, called the Diaquarium. An overview of 36 types and categories of in-game rewards and 6 reward schedules have been addressed. The constructed game has been designed through research-based methods and provides knowledge regarding how nourishment, blood glucose levels, and insulin interacts for individuals with Type 1 Diabetes Mellitus. An early prototype has been developed to demonstrate its concept and some of the game mechanisms with help of Unity 3D game engine and C# programming language. Game design, requirements and suggestions for the project was gathered through literature review, attending workshops, meetings and discussions with experts, as well as feedback from a potential user group. On the final stage of research, an anonymous questionnaire for children was distributed to an elementary school class, involving nine 9-year-old children. The questionnaire examined and collected feedback regarding the game outline, usability, and preferred reward mechanisms in the Diaquarium. Despite a short period of testing and a limited test group with non-diabetic children, the game was recognized as attractive and moderately difficult within the potential user group. Accordingly, n = 8 answered that they liked the game and were highly interested in playing it one day. Also, n = 8 answered positively with respect to illustrations and colors used in the game. The analysis suggests that rewards are highly a matter of preference. Simultaneously, there were indications that some of the rewards were more favorable than others and vice versa. It appears that rewards serving a purpose within the game, e.g. potentially effect progression in the gameplay, is more favorable than the opposite rewards serving no purpose. The findings were highly valued and taken into consideration during the design process of exploring the in-game rewards of the Diaquarium.