UNSTRUCTURED
Introduction
Games, when used as interventional tools, can influence behavior change by incentivizing, reinforcing, educating, providing feedback loops, prompting, persuading or providing meaning, fun and community. However, not all game elements will appeal to consumers equally, and different elements might work for different people and in different contexts.
Methods
A realist review was conducted to inform program theory in the development of tabletop games for health behavior change. Context, mechanisms used to change behavior and outcomes of included studies were reviewed through a realist lens.
Results
31 articles met eligibility criteria and were included in the review. Several design methods were identified that enhanced efficacy of games to change behavior. These included design by local teams, pilot testing, clearly defined targets of behavior change, conscious attention to all aspects of game design including game mechanics, dynamics, aesthetics, and the elicitation of emotions. Delivery with other mediums, leveraging behavioral insights, prior training for delivery and repeated play were also important. Some design elements that were found to reduce efficacy included limited re-playability or lack of ‘fun’ for immersive engagement.
Discussion
Game design needs to consider all aspects of the context and the mechanisms to achieve the desired behavior change outcomes. Careful design thinking should include consideration of the game mechanics, dynamics, aesthetics, emotions and contexts of the game and the players. People who know the players and the contexts well should design the games or have significant input. Testing in real-world settings is likely to lead to better outcomes. Careful selection and purposeful design of the behavior change mechanisms at play is essential. Fun and enjoyment of the player should be considered, as without engagement there will be no desired intervention effect.
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