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Background: Physical activity has multiple health benefits; however, the majority of children around the world do not attain the recommended levels of daily physical activity. Research has shown that the game Pokémon GO has increased the amount of physical activity of players and that the game has the potential to reach populations that traditionally have low levels of physical activity. Therefore, there is a need to understand which game components can promote initial and sustained physical activity. By using a qualitative research approach, it is possible to achieve rich descriptions and enhance a deep understanding of the components promoting physical activity among children in a game such as Pokémon GO. Objective: The objective of this study was to explore children’s and parents’ experiences playing Pokémon GO. Methods: Eight families comprising 13 children (aged 7-12 years) and 9 parents were selected using purposeful sampling. Data collected using focus groups were analyzed using qualitative latent content analysis. Results: The following three themes were revealed: (1) exciting and enjoyable exploration; (2) dangers and disadvantages; and (3) cooperation conquers competition. The first centers around the present and possible future aspects of Pokémon GO that promote physical activity. The second focuses on unwanted aspects and specific threats to safety when playing the game. The third shows that cooperation and togetherness are highly valued by the participants and that competition is fun but less important. Conclusions: Components from Pokémon GO could enhance the efficacy of physical activity interventions. Cooperation and exploration are aspects of the game that preferably could be transferred into interventions aimed at promoting children’s physical activity. (JMIR Serious Games 2018;6(1):e1) doi: 10.2196/games.8979 KEYWORDS child; cell phone; parents; exercise; mobile apps of children around the world do not reach this level . Introduction Excessive use of technology has been suggested as a contributing factor to childhood inactivity . However, Participation in physical activities has multiple health benefits research also recognizes that games that incentivize exercise for children . It also provides cognitive benefits, including have the potential to promote children’s physical activity . facilitating learning and academic achievement [2,3]. The World Health Organization recommends that children be physically active for at least 60 min daily . Unfortunately, the majority http://games.jmir.org/2018/1/e1/ JMIR Serious Games 2018 | vol. 6 | iss. 1 | e1 | p. 1 (page number not for citation purposes) XSL FO RenderX JMIR SERIOUS GAMES Lindqvist et al Pokémon GO is a mobile game where fictional Pokémon selected using purposeful sampling. Eight families comprising creatures are captured and trained . Niantic, the developer, 13 children and 9 parents agreed to participate. Participant uses an augmented reality technique where live direct views of information is shown in Table 1. Krueger and Casey  a real-world environment are augmented by computer-generated recommended having a homogeneous composition of focus graphics to create a geocaching (ie, geographic search) game groups in terms of age and sex, for example. However, we chose where Pokémon characters are sought. Supplementing the real to distribute participants in the focus groups based on family world with computer imagery allows players to become affiliation because we wanted to capture the reflections from immersed in the game, requiring them to be physically active the parents on the opinions of the children and vice versa. We to capture and hatch new Pokémon . Some studies suggest paid extra attention to letting the children tell their stories that Pokémon GO increases physical activity and discourages because they could automatically have a sense of less power in sedentary behavior among adults [8-11]. However, another this situation. study showed that although the number of steps increased at Data Collection the beginning, it gradually decreased and returned to previous In December 2016, data were collected using focus groups. A levels 9 weeks after downloading the game . Nevertheless, semi structured interview guide was constructed to ensure all the authors conclude that the effect of Pokémon GO on physical aspects of the aim were addressed. The opening question was, activity might be different in children . Moreover, the game “Let’s pretend I know nothing. Could you please tell me about might have the potential to reach populations that traditionally Pokémon GO?” To persuade informants to expound on their have low levels of physical activity (preteens and teens) and answers, follow-up questions, such as “Could you tell me promote their physical activity . Despite the potential benefits more?” and “How did you experience that?” were asked . of the game, negative effects, such as increased risk of injury, Each family formed a focus group consisting of 1 or 2 children abduction, and trespassing, threaten the safety and physical and 1 or 2 parents, and the interviews lasted between 30 and 60 well-being of children [13,14]. Further research with children min. The focus group interviews were performed by the first is needed to understand which game components promote initial and last authors, and they were audio recorded and transcribed and sustained physical activity . To the best of our verbatim. knowledge, this is the first qualitative study of both children and parents aiming to develop an understanding of the Data Analysis underlying mechanisms of Pokémon GO so that this knowledge The qualitative latent content analysis was inspired by can be transferred to physical activity interventions for children. Graneheim and Lundman . First, transcriptions were read We aimed to explore children’s and parents’ experiences playing several times to obtain a sense of the overall data; second, the Pokémon GO to determine which components make physical text was divided into meaning units; and third, the meaning activity games attractive. units were coded, and these codes were compared, contrasted, and sorted into themes while maintaining fidelity with the text. Methods To strengthen the credibility of the study, the first and last authors initially performed their analyses separately. Then, Design differences in coding and sorting were discussed, and consensus This qualitative study is one of the several studies of the process was reached. The second and third authors made comments of developing gamification-inspired programs to promote about the result to add to readability and clarity. To further physical activity in children. Qualitative methods provide the strengthen the credibility of the study, quotes were used to opportunity to achieve rich descriptions, enhance understanding illustrate our interpretations. of a phenomenon, and capture the voices of people who are Ethical Approval rarely heard (ie, the children) . Thus, a qualitative approach This study was performed in accordance with the principles of to gamification research has the potential to identify the the World Medical Association’s Declaration of Helsinki: components that make physical activity games attractive to Ethical Principles for Medical Research Involving Human promote physical activity among children and adolescents. Subjects. Each participant signed an informed consent before Participants participating in the study. This study was approved by the Children aged 7 to 12 years and their parents living in a Regional Ethical Board in Umeå, Sweden, before the start of municipality of approximately 80,000 inhabitants situated in the research project (issue date: February 9, 2016; Application north Sweden with experience playing Pokémon GO were Registration Number: 2015/296-31Ö). http://games.jmir.org/2018/1/e1/ JMIR Serious Games 2018 | vol. 6 | iss. 1 | e1 | p. 2 (page number not for citation purposes) XSL FO RenderX JMIR SERIOUS GAMES Lindqvist et al Table 1. Characteristics of the children and parents who participated in the focus groups. Numbers of informants Age in years, mean (range) Education Pokémon GO experience Time played in months, Level, mean (range) mean (range) Boys: 9 9.1 (7-12) First to sixth grade 3.1 (2-4) 22.7 (17-29) Girls: 4 9.8 (9-11) Third to fifth grade 3.2 (3-4) 12.0 (4-22) Parents: 7 mothers and 2 fathers 38.7 (31-49) Higher education (7) or high 2.9 (1-4) 17.4 (0-30) school (2) Both children and parents stated that to keep their interest, it Results was important that new things happen in the game. Examples were the ability to catch rare new Pokémon or participate in The analysis rendered the following three themes: exciting and special events that appeared in the game. For instance, on enjoyable exploration, dangers and disadvantages, and Halloween, more experience points (XP) and candies could be cooperation conquers competition. earned. Moreover, bonuses for playing every day during a Exciting and Enjoyable Exploration certain period increased the desire to play. A common wish for future game development was allowing friends to trade As the game requires exploration of the participant’s Pokémon. As some Pokémon exist only on one continent, it neighborhood for fictional characters that appear and “hatching” was desirable to have a chat function that allowed people from of Pokémon eggs, almost all respondents described the game various parts of the world to connect and exchange Pokémon. as increasing their physical activity, especially when the game In addition, players expressed the desire to collaborate with was new. In the beginning, it was often played every day, and others and play together, build a joint Pokédex, and so on. sometimes weekend trips were taken with the sole goal of Furthermore, they suggested having a map so that friends could catching Pokémon. It was fun and exciting to catch a new be located. Another wish for development was having the ability Pokémon and add it to the Pokédex. Having a full Pokédex was to do more with their Pokémon than fight in a gym, as shown a goal for some players; however, with the release of new in the quoted text below: Pokémon, this was difficult. Having captured a Pokémon that nobody else had gave feelings of uniqueness and gave extra Father: I think it would be interesting if you could spice to the game. In addition, it was exciting to evolve a trade Pokémons with each other. The game started Pokémon by giving it candies, which players earned by being as a trading game, and you could trade cards with physically active. Some players said they walked hundreds of each other and collect them. kilometers on “Poké-walks” to catch Pokémon, get candies, or Mother: What if you could get to know someone in, incubate eggs, not knowing which Pokémon would be gained, for example, USA, and they could catch one for you as shown in the quoted text below: there, that doesn´t exist here? Or if a family or a Boy: The game is really exciting. A couple of days group of friends could play in the same team and have ago, we saw that Pikachu was nearby, and we hurried a joint Pokédex. up with clothes and ran there. But he had disappeared Girl: It would have been so much more fun if you when we came there, and we got really disappointed. were able to play together with friends. Mother: Suddenly, he appeared again and I just shouted out. Exactly, and I think that this could be motivating for A woman was walking by and just looked at me, but physical activity. [Focus Group 1] I was so involved in the game. [Focus Group 6] Dangers and Disadvantages One highlighted advantage of Pokémon GO was that it combines playing with being outside and moving around. Parents often A few children described having small accidents, such as falling encouraged their children to play and vice versa. The children into a ditch or biking into a mailbox, when playing. Furthermore, wanted their parents to come along on Pokémon walks. Parents some parents were afraid that their children would walk into a told how easy it was to get their children to go for a walk or road with traffic without acknowledging the consequences. join a trip to the city, which earlier had not been so appreciated. Some parents limited where their children could play the game, Some parents, primarily those who played together with their and one parent did not allow his son to go outside alone in the children, began to take extra walks during lunch breaks or in evenings when it was dark. When playing the game, it was the evenings just to progress in the game. In that way, the game difficult to heed one’s surroundings, making it possible to hurt led to increased everyday physical activity, as shown in the oneself. In addition, one could miss things in nature, such as a quoted text below: squirrel or something else in the real world. One family acknowledged that walking around with a phone in hand at all Father: We went on a walk last night, all three of us. times increased the risk of theft. Some parents noticed that by I think we were outside one hour. Earlier, we have playing the game, it became acceptable to walk around with the never gone walking that far and especially my son phone in one hand even when not playing the game, as shown has not earlier been the one pushing us to go out in the quoted text below: walking. [Focus Group 4] http://games.jmir.org/2018/1/e1/ JMIR Serious Games 2018 | vol. 6 | iss. 1 | e1 | p. 3 (page number not for citation purposes) XSL FO RenderX JMIR SERIOUS GAMES Lindqvist et al Mother: I think it is bad that the game is built on things such as who found or scouted a rare Pokémon. This having the phone in the hand when moving around brought about new friendships throughout the school. Showing since it makes it ok for the children to have the phone others a rare Pokémon was described as fun, and others were in the hand in other situations too, like when playing interested in hearing about it. Sometimes, lot of attention was Clash of Clans or using Snapchat. Girl: Yes, but Snap given by people they did not know. At some locations, many is social. Mother: I know, but earlier you sat down, players would gather, and it was common for players to start and walking around with the phone makes you not talking to others in the same manner that dog owners start pay attention to your surroundings. For example, my talking to each other about their dogs. For one boy, this game son can go downstairs with his eyes on the phone, facilitated making friends, something that he previously found and one day he could break his neck falling down, challenging, as shown in the quoted text below: and Pokémon GO has opened up this behavior. [Focus Mother: My boy has had difficulties interacting with Group 3] peers. Most of them like to play football. Now he has Overall, parents emphasized the challenge in limiting the time found friends with the same interests, and his social their children spent playing computer and mobile games. As skills grow every day. [Focus Group 7] they saw several advantages of being physically active and being Some parents and children played on the same phone or using outside, they were less likely to limit the time spent on this the same login, thereby cooperating in progressing through the game. In addition, parents who played with their children relaxed game. This added another dimension to the game, and they often their rules about screen time. Moreover, some families talked about which Pokémon was caught, or they were motivated experienced conflicts when playing the game. For instance, one to be more active in the game. Both parents and children boy became hysterical when he was disallowed from going described how cooperation was an important factor to continue outside to catch a rare Pokémon that he really wanted, as shown playing the game, and it motivated them to play a lot. In one in the quoted text below: family, 2 children and their mother played using a single login, Mother: My sister sent a message that a really rare and the daughter would not play at all if not doing it together. Pokémon was in the city, and my son really wanted Furthermore, cooperation created the opportunity for interacting to go there, and we couldn´t. It ended in a real fight, with the children and talking about other things, such as school, and he got really sad, which I can understand because while walking together and playing the game; this is not possible he really wanted that. I have also heard from friends with other computer-related activities. In addition, playing about children becoming hysteric, as it is important together allowed parents to be more involved in the game to them to catch a Pokémon somewhere. It is like an compared with other computer or mobile games that their obsessed behavior. [Focus Group 5] children played, as shown in the quoted text below: Some families mentioned that others cheat in the game. Two Girl: When I come home and have caught something, boys gave up playing when it became obvious that some of their I say, “Wow, look at what I have caught.” Boy: friends were cheating, and they thought, “why bother playing” Helping each other makes it more fun; it is thanks to when it is possible to progress in the game incorrectly. Another mother that we have made this progress in the game. family refrained from using cheats because they took pride in Mother: No, it is thanks to you both and the making progress without using them. A practical problem that cooperation that we have reached this far. [Focus occurred with many parents was that their children stayed out Group 2] playing until the phone battery died. When this happened, the parent and the child could not contact each other in the usual Discussion way. This was a particularly large problem in the winter when Principal Findings phone batteries are much less effective. It also led to a need for keeping the phone in a pocket, making it more difficult to play. This study shows that the components of the game that the In addition, several respondents commented on the relative ease participants valued most were predominately linked to exploring of playing in the summer when it was more comfortable because and socializing, and only a few players valued fighting in the less clothing was needed to play outside, especially for a long gym. We found that the social aspect of the game dominated; time. comments about walking together, cooperating using a single account, making new friends, and sharing a common interest Cooperation Conquers Competition in the game prevailed. This finding is not in line with the Cooperation and togetherness were highly valued by the findings of Rasche et al , who found that social interaction participants, and without a doubt, this was highlighted before was not affected by playing the game. In their case, the focus competition. Nevertheless, winning a gym fight and competing was predominantly on adults, and it is reasonable to believe that against other players were mentioned as fun activities, especially children as well as families act differently. The second-most among the boys in the study. Through these features of the prominent classification was that of the explorers who game, they could measure who was best in the area. Those commented about exploring new places to find new Pokémon, players who liked competing in the gym were motivated to being excited about spotting a rare Pokémon, hatching a new reach higher levels in the game. One aspect of the game that Pokémon, and being able to show off their rare and developed was especially appreciated was that it led to new friends. The Pokémon. Our findings suggest that gaming elements, such as children talked a lot about the game while at school, discussing cooperating and exploring, inspire participation in physical http://games.jmir.org/2018/1/e1/ JMIR Serious Games 2018 | vol. 6 | iss. 1 | e1 | p. 4 (page number not for citation purposes) XSL FO RenderX JMIR SERIOUS GAMES Lindqvist et al activities. These components of the game can be valuable when and goal achievement . Self-observation, or having an designing physical activity interventions using gamification. In awareness of one’s performance, does not by itself result in a earlier research, game characteristics shown to promote physical sustainable behavior change, but the inclusion of both regularity activity were cooperative play, ﬂexibility in activity choices, and proximity can enhance its effects on motivation . It is short-term goals, integration of physical activities with elements the consistency of the success (eg, if I am physically active, of a story or narrative, rewards, and replayability . Moreover, then I am more likely to catch a Pokémon) and the timing of evidence supports that cooperative gaming offers more intrinsic the feedback that influences behavior. The components that motivation, self-efﬁcacy, enjoyment, and continued participation make physical activity games addictive might be transferable, than solitary play . An increase in motivation is crucial to and gamification components have been used previously to physical activity interventions because motivation promotes improve the effectiveness of health promotions , and adherence and attendance, two factors necessary for creating promising research demonstrates the use of gamification with lasting behaviors and physiological changes . the aim of promoting physical activity . For instance, we are currently developing an intervention promoting children’s Our findings show that playing Pokémon GO is not without active school transportation, and that intervention will draw some risk; however, learning to navigate environmental risks upon the design patterns from Pokémon GO. is a natural part of growth and maturation. Furthermore, the sustainability of the new behaviors is inherently based on the Limitations elements of the game, such as gaining access to new characters This is a qualitative study that provides a rich description of or a joint Pokédex. Thus, the increased physical activity families’ experiences playing Pokémon GO, and it therefore evidenced in this study remains largely dependent on the game enhances the understanding of how mobile games can promote and is therefore not likely sustainable. The bidirectional and physical activity as well as capture the voices of people who reciprocal nature of the social cognitive theory  can explain are rarely heard (ie, the children) . This study is limited in underlying tenets related to the discoveries in this study. Using that we used only 8 families; however, the last 2 focus group the game as the context, participants could begin to model interviews did not add new insights, indicating saturation in the behaviors that lead to success in the game because this data. This small sample limits the transferability of the results, experience brings joy to their lives. Players learn from each but the knowledge gained by this study might be transferable experience how best to locate, lure, and catch Pokémon. When to physical activity interventions for children. successful, the behaviors are replicated. Thus, social learning Conclusions through watching and cooperating with others to catch specific characters helps shape the new behavior of daily participation As cooperation and exploration were the motivating aspects of in physical activities. Visiting new locations and being Pokémon GO that were most appreciated by the families and physically active increased the likelihood of success, and it was most inspiring to increase physical activity, they could be the behavior that linked feelings of enjoyment and excitement advantageous aspects of gamification when building physical with the environment even though it was through a virtual, activity interventions for children. For example, including augmented environment. In other words, the game players were elements of surprise and cooperation with friends and parents, rewarded for their behaviors regardless of whether the behavior such as collecting points or badges together, might be useful. was modeled by another player or by the game itself. 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[doi: 10.1089/g4h.2014.0095] [Medline: 26181809] Edited by A McDougall; submitted 19.09.17; peer-reviewed by J Bullard, P Rasche; comments to author 20.10.17; revised version received 15.11.17; accepted 29.11.17; published 03.01.18 Please cite as: Lindqvist AK, Castelli D, Hallberg J, Rutberg S JMIR Serious Games 2018;6(1):e1 URL: http://games.jmir.org/2018/1/e1/ doi: 10.2196/games.8979 PMID: 29298750 http://games.jmir.org/2018/1/e1/ JMIR Serious Games 2018 | vol. 6 | iss. 1 | e1 | p. 6 (page number not for citation purposes) XSL FO RenderX JMIR SERIOUS GAMES Lindqvist et al ©Anna-Karin Lindqvist, Darla Castelli, Josef Hallberg, Stina Rutberg. Originally published in JMIR Serious Games (http://games.jmir.org), 03.01.2018. This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Serious Games, is properly cited. The complete bibliographic information, a link to the original publication on http://games.jmir.org, as well as this copyright and license information must be included. http://games.jmir.org/2018/1/e1/ JMIR Serious Games 2018 | vol. 6 | iss. 1 | e1 | p. 7 (page number not for citation purposes) XSL FO RenderX
JMIR Serious Games – JMIR Publications
Published: Jan 3, 2018
Keywords: child; cell phone; parents; exercise; mobile apps
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