Risk Prevention Education: the Challenges of Gamification

By December 15, 2014 3 comments

Researchers at the University of Texas have been looking at the use of gamification to address critical public health and social issues among young people and have published a report detailing the challenges that need to be met if this approach to social education is to work properly.

For some years now educators have been using games to raise young people’s awareness of various social issues. The Yale School of Medicine created a video game to help educate 9-14 year-olds about the risks of sexually transmitted diseases, alcohol and drugs and how to prevent them. Called Play2Prevent, the venture cost close to $4 million dollars, but it has not proved problem-free. Against this general background, Dick Shoech and other faculty members at the University of Texas decided to look deeper into the subject in order to try and grasp the issues and understand the challenges of using games techniques to engage with a school-age audience. They have created a web-tablet game called Choices & Consequences, which is designed to teach youngsters how to avoid substance abuse and relationship violence problems. It has been tested in a school in the United States and the creators have analysed the challenges it threw up. It seems clear that using games techniques – including rewards for making correct choices – can be an excellent way of getting adolescents to engage with the issues and encouraging them to take their own decisions. Nevertheless, creating and implementing this type of game is not without its difficulties.

Designing a long-running game

Given that the basic aim of this type of game is risk prevention, it cannot be a one-off exercise but must be based on a programme that is repeatable long term. The Texas researchers stress in their conclusions that such a game must be designed to support young people for a number of weeks or months rather than engaging their attention for a matter of hours and then being quickly forgotten. The basic challenge is therefore to come up with a scenario that can stay the course and continue to be fun to play and not become boring or seem unrealistic. In the same vein, the researchers wanted to create a game that could be adapted to the various needs of different schools and parents, who do not all share the same goals or take the same view of such sensitive social issues as drug use, unprotected sex and violence/bullying in relationships.  The Choices & Consequences developers therefore set out to create a game which did not impose a monolithic view of things but could be adapted according to the demands of particular schools or parents.

Interaction through social networking and feedback

The second major challenge facing Professor Dick Shoech and his team was how to set up highly realistic scenarios so as to really encourage the young players to interact with the game. To obtain some background, they worked with a panel of college and high school students who were involved with drugs or experiencing relationship violence in order to get a handle on the language and expressions they were actually using and bring this realistic dialogue into the game. They then created a platform to channel all feedback from the players – from score statistics to comments on the game, which the users can post at any time during the game. In addition they provided the players with the option of discussing the game on Facebook. A coordinator runs the discussions, with the aim of creating a real discussion community. It became clear however that while setting up a game in a single school and putting in place a discussion mechanism and coordinator is not too difficult, a much larger programme requires staff and considerable resources. A major conclusion is that no matter how much fun the game is to play, if the youngsters soon forget all about it, the endeavour will have been wasted.  Nowadays gamification is becoming popular in such serious fields as healthcare and sustainable development, but the specific key challenge for games developers when it comes to addressing risk prevention among teenagers seems to be follow-up and continuity.

Page top


As the Founder and Director of the play2PREVENT Lab at Yale, I feel it is important to point out erroneous reporting about our project reported in this article.

1. So far as I know, no one on our team was contacted to comment on the notion that our project has had problems. While we have highlighted challenges, and openly discussed the processes we refined to build the game to help others building health games, we've never reported anything resembling problems with the project. Perhaps it is just a question of wording, but the article here seems to try and draw inference between our budget as not somehow inoculating us against the challenges all research seeks to identify and address.

In fact, the project continues to go extremely well and is essentially problem-free.

The cited budget for the game developed by the play2PREVENT Lab, PlayForward: Elm City Stories, while correct, is not completely accurate in its presentation. The game itself cost a fraction of the total budget that covers not only the development of the game, but the full-scale (N=333) randomized clinical trial the game is undergoing over the course of a two-year period. One of the problems in the games for health field is the lack of large rigorously conducted trials that this project seeks to address given its budget and approach. In addition, the trial does not include any other interventions such as mentors using the game, or additional offline materials. We are evaluating, the game, and only the game's impact both short-term, and long-term over a 2-year period in young teens, aged 11-14 years (not 9-14) in their community after-school programs.

2. The article reports that the Texas researchers feel a game must be "designed to support young people for a number of weeks or months rather than engaging their attention for a matter of hours and then being quickly forgotten." Our game, on average was played for 10 hours over a six-week period as part of the trial. We are in the process of rigorously evaluating exactly what amount of gameplay time and exposure to which game components results in the most impact on behavioral antecedents and actual behaviors. Therefore, the question regarding “dose-response,” in many ways, is still a work in progress. The fact is that issues around dosage of play are not well settled and may be entirely contextual to the underlying issue, the game's overall design, and many other factors.

We can certainly provide stronger facts about our project and its successful implementation. We have published widely in peer-reviewed journal on the formative developmental phase of the project and will be publishing shortly on our RCT data.

Submitted by Lynn Fiellin, M.D. (not verified) - on December 17, 2014 at 05:00 pm

I am also a member of the Play2PREVENT team and aside from the comments posted by Dr. Fiellin I would also add that the article conflates the term gamification and game, a common problem in the field and one that the UT researchers didn't necessarily address well in their paper. While clearly using more specific definitions of gamification vs. games properly upfront in their own publication, the UT team goes on to cite numerous game projects such as Play2Prevent, and game studies which in my opinion further dilutes the substantive differences between games and gamification. This article then continues that problem by virtue of its reporting.

Full-fledged games are popular, and seen as powerful and engaging, so gamification advocates (and not necessarily UT's research team) seek to appropriate the goodwill of full-fledged games when discussing the lesser approach of gamification. Taking parts of games, and using them to improve social media applications, Web interfaces, or other media may have merit in-and-of-itself, but the vast majority of game players would see no similarities between gamified apps and their favorite games.

Full-fledged games, are not the same thing as gamification, and there is a litany of criticism surrounding the use of gamification as a term, and as a practice by game designers, and others concerning effectiveness, advocacy, and the differences from well designed fully playable games like PlayForward.

Submitted by Ben Sawyer (not verified) - on December 17, 2014 at 05:42 pm

Gamified education is actually our future. It's most simple way to engage students, also - develop their practical skills. Strongly suggest to try out http://virtonomics.com.

Submitted by Renata (not verified) - on January 22, 2015 at 03:22 pm

Legal mentions © L’Atelier BNP Paribas