The importance of involving final users to develop games for training cognitive skills.

User-centered design (UCD) is about designing and developing a product from the perspective of how it will be understood and used by your user rather than making users adapt their behaviours to use a product. The idea is to offer a product which would support its users’ existing beliefs, values, attitudes, and habits. The user-centered design method is typically used to understand how to realize meaningful game-based experiences for health purposes, as well as rehabilitation or training (as well as for other kinds of software applications)1. This approach is based on the collaboration between end-users and researchers through focus groups and/or interviews. Based on the results collected through this approach clear requirements and specifications can be formulated, that will serve for a co-design phase. UCD is important for deciding the most appropriate game mechanics and for fine tuning the usability aspects of the system. More specifically, focus groups and other methods (e.g. interviews) will be used in order to collect quantitative as well as qualitative data and specifically to understand the needs and requirements of users as well as their reactions and emotions while interacting with the system under development. The UCD is an iterative methodology based on different cycles where final users are involved to collect feedback, aiming at fine-tune the system, till it can be considered fully usable and acceptable by the user group. The concept of putting the user at the center of a game design process is key to realize meaningful, effective experiences for users and achieve behavior change goals. Meaningful game design for behavior change is more challenging to achieve, if compared to the design of digital games for leisure or entertainment context where game rules and patterns can more easily and effectively be applied. In game design for non-leisure context game elements (the so-called ‘serious games’) need to be derived from aspects of the underlying activity that are meaningful to the user.

Published papers have shown that providing only external rewards to motivate change might not be enough to produce the desired outcomes, nor be an ideal solution; instead, providing clear connections between the game elements and important aspects of the relevant non-game activity (as well as user’s own goals and desires) can bring more benefits and stable outcomes. Also, since users have different needs and preferences, another design challenge consists in providing a flexible gaming environment that can be personalized and customized to meet individual needs and be perceived as meaningful by the different target users. We can observe an example of this methodology during the different phases of the SustAge project. SustAge aims at creating a system for the cognitive training of workers, hence it is important to involve final users (workers themselves) to study their habits, their needs and their expectations to design an efficient game-based solution able to motivate them to engage in a behavioural change process and to increase their compliance to the training plan. Each user (or group of users) should also provide feedback and ratings on their user experience, perceived usefulness and motivation to use the system. Collected data are then analysed to identify the main points of strength and weakness of the solutions tested and inspire next development phases.

Cognitive skills training is strictly related to adherence to clinical instructions and willingness to follow training plans: compliance is the related term that has been defined as the extent to which a person’s behavior coincides with training advice given 2. In 1975, Becker and Maiman were already able to study this topic, highlighting that many factors are implied in compliance, namely health beliefs, motivations, and perception of psychological costs of the recommended actions3. Nowadays, other studies have shown that technology may help increase compliance for people with chronic illnesses. E.g. A basic intervention for chronic pain has been tested by Palermo et al., who compared the use of an electronic diary with a paper-and-pencil diary. The authors found out that the eHealth solution led to greater compliance and accuracy in diary recording4. Still, similar interventions – trying to enhance compliance through mobile ecological momentary assessment (mainly collecting user data via mobile devices to track daily actions) – need to be improved. Wen et al. provided a meta‑analysis reporting moderate but suboptimal compliance rates, especially noting high efficacy for reporting good practices to users5.

Serious games (SGs) can be a means of tackling the various aspects related to compliance, such as fostering motivation, skill empowerment, and education. SGs are computer games, aiming not only at entertaining the player, but also at exploiting the entertaining qualities for training, education, and health 6. They are an example of positive technologies, a digital solution that shapes new opportunities for individual and collective learning and training, capable of supporting health and well‑being 7,8. Connolly et al.’s systematic review analyzed 129 papers investigating computer games with respect to learning, skill enhancement, and engagement, highlighting that the most frequently occurring outcomes and impacts were knowledge acquisition/content understanding and affective and motivational outcomes9. Based on this common assumption that SGs work both on changing cognitive processes and affecting motivation, Wouters et al. compared them to conventional instruction methods, finding out that SGs are more effective in terms of learning and retention, even if they are not more motivating. They also identified factors that increase. SGs’ effectiveness such as multiple training sessions and multiplayer modalities10.

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