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- JMIR Publications
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- Copyright © The Author(s). Licensed under Creative Commons Attribution cc-by 4.0
- ISSN
- 2291-9279
- DOI
- 10.2196/16031
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- See Article on Publisher Site
Abstract
Background: Physical activity is crucial for child obesity prevention and intervention. Narratives embedded in active games can increase children’s physical activity. Objective: Little is known about the narrative characteristics that would motivate children to exercise. We attempted to fill the gaps in understanding regarding narrative design for active video games. Methods: In this exploratory study, four animated narratives of different genres were professionally generated. Children (N=41) between the ages of 8 and 12 years were interviewed to identify their preferences. Sessions were digitally recorded, transcribed, and analyzed using exploratory thematic analysis. Results: Findings revealed that the children rated the dystopian science fiction story as their favorite across all weight, race, and gender groups. The physical activity-friendly narrative strategies included virtuous characters, extraordinary character actions, interesting plots, super powers, and engaging cliffhangers. Alternatively, information not related to physical activity, difficult-to-follow plot lines, passive protagonists, and repetitive narrative tropes were less appealing for physical activity. Conclusions: This research provides preliminary evidence that narratives have characteristics that may increase child physical activity when playing active games. Future empirical studies should verify and test these design principles. (JMIR Serious Games 2019;7(4):e16031) doi: 10.2196/16031 KEYWORDS narrative; physical activity; active game; children; thematic analysis diseases such as cardiovascular disease, diabetes, and several Introduction types of cancers [4]. Background Physical activity (PA) is a critical strategy for child obesity prevention [5]. While it is recommended that children participate Childhood obesity is a growing epidemic in the United States in 60 minutes or more of PA every day [6], less than one-quarter and beyond [1]. In 2016, 340 million youth aged 5 to 19 years meet the recommendation [7]. Most PA interventions have not around the world were overweight or obese [2]. The obesity achieved long-term effects, with lack of access and motivation trend is increasing among many groups, with no ages seeing a identified as key challenges [8]. decrease [3]. Obesity is a major risk factor for noncommunicable http://games.jmir.org/2019/4/e16031/ JMIR Serious Games 2019 | vol. 7 | iss. 4 | e16031 | p. 1 (page number not for citation purposes) XSL FO RenderX JMIR SERIOUS GAMES Lu et al Active video games (AVGs) require body movement to play organizing events into a logically unfolding sequence or [9] and may increase PA in an enjoyable manner [10]. With the temporal order [33]. international popularity of Dance Dance Revolution (Konami), Narratives have strong potential for health promotion by Wii (Nintendo), and Pokémon Go (Niantic), AVG became influencing cognition, affect, and behavior through recognized as an independent genre. In the United States, transportation [34,35]. Transportation is narrative’s unique approximately two-thirds of people play video games daily, and immersive quality that enables the suspension of disbelief, 70% of families have a child who plays video games [11]. All instills vivid personal experience, and creates deep affection major consoles offer AVG devices [12]. AVG may also for characters [36]. encourage PA among children in unsafe neighborhoods lacking safe outdoor alternatives [13]. The advancement of AVG systems has created numerous opportunities for narratives to be better woven with the digital Many AVGs, though, are perceived to be less enjoyable than technologies and, in addition, helps amplify the foundational sedentary games and are less likely to be played over time [14]. mechanisms of narrative persuasion. For example, the interactive Most gamers do not complete their games [15] as they often nature of AVGs enhances player engagement with the characters lack long-term motivational appeal [16,17]. Novel and through increased character identification, interpersonal interdisciplinary approaches are needed to sustain AVG play attraction, and parasocial interaction. An appealing plot helps [18]. players to go beyond the spectator level to become an active Narratives, or stories, possess unique motivational properties participant and fosters greater engagement with the plot through that may encourage increased AVG play [19]. While narratives gameplay. Therefore, an engaging AVG with appealing appear in some health games, few AVGs capable of achieving characters and plots could induce a strong intrinsic motivation moderate to vigorous physical activity (MVPA) have to play exergames by reducing cognitive load [37,38] through incorporated them [20-22]. Recent studies have tested the ability immersive qualities [39], engendering a positive and powerful of added narratives to induce PA through AVG play. An arousal and attention [40], enhancing character identification exploratory study that interspersed narrative cutscenes (ie, brief, [41], and absorbing players in a story world [42]. The AVG animated narrative video clips) in an existing AVG without a play experience, once integrated with narratives, would narrative found that children aged 8 to 12 years in the narrative internalize reward mechanisms within the players and in turn condition had 40% more objectively measured steps than their help foster the perception of exercise through AVG as necessary counterparts who played the nonnarrative version of the same [19]. game [23]. Similar results were found in another study involving Narratives and Behavior Change Theories college students; the narrative increased MVPA by 58% [24]. The potential of using narratives can be partly explained by Both of the aforementioned studies featured narratives that synergies of narrative with several widely used behavioral included fantastical elements. For example, the first study used change theories: theory of planned behavior, social cognitive a mystery-themed story of a modern child absorbed into a game theory, and self-determination theory. Specifically, the theory world trying to find the way back home [23]. The second of planned behavior [43] posits that a person’s behavior is a featured an ordinary person fending off swarms of monsters to function of the intention to perform that behavior, which in turn protect the world [24]. However, the question remains as to is a function of the attitude toward performing the behavior, what narrative elements motivate children to engage in PA. subjective norms, and perceived behavioral control. With their Two exploratory studies provided preliminary insight: actions immersive process, the inclusion of narratives in AVGs may related to PA should be a central narrative element, a credible make PA seem fun (changing attitudes), may show other PA motivation should be incorporated, and characters should characters engaged in PA (which may affect social norms), and be likeable [25,26]. These studies, however, did not employ a can make the behavior seem easy to do (increasing perceived theoretical foundation for analysis and largely consisted of behavioral control), thus inducing a more positive attitude, more anecdotal observations. positive subjective norms, and greater perceived behavioral control toward performing healthy behaviors [44]. The elusive narrative characteristics that would best motivate PA among children should be explored with the guidance of Social cognitive theory highlights observational learning, or interdisciplinary theories and in-depth analysis of children’s vicarious acquisition of knowledge from the social environment, feedback about the AVG narratives [27]. Here we attempt to as a primary source of information [31,32]. A narrative AVG fill this gap by exploring narrative design principles. has potential through character actions to convey observational learning and useful strategies, model effective style, and Narratives for Health Promotion in an Interactive demonstrate how to use these strategies, thus enhancing players’ Technology Age self-efficacy (the belief in one’s capability to achieve different A narrative is defined as any two or more events arranged in a levels of performance), a key construct of social cognitive theory temporal order [28]. Characters and plot are primary components and a similar concept to perceived behavioral control in the of narratives. The characters are a major structural property and theory of planned behavior. The AVG can also offer multiple driving force [29], serving as an internal source of beliefs [30]. vicarious experiences to the players to show the consequences As described by social cognitive theory [31,32], characters also of undesirable versus desirable behaviors. function as role models. The plot plays a pivotal role by http://games.jmir.org/2019/4/e16031/ JMIR Serious Games 2019 | vol. 7 | iss. 4 | e16031 | p. 2 (page number not for citation purposes) XSL FO RenderX JMIR SERIOUS GAMES Lu et al Self-determination theory considers human behavior to be driven arcs to be integrated seamlessly into an existing AVG that had by autonomous and controlled motivation [45]. Narrative been found to induce MVPA through the Kinect sensor on the enjoyment through AVG play can be an intrinsically rewarding Xbox console: Shape Up (Ubisoft) [61]. To ensure the narratives activity sought by people independent of extrinsic rewards by would be engaging and developmentally appropriate, we providing intriguing internal incentives for audiences who, in conducted individual cognitive interviews with 41 children the role of characters, feel immersed in the story [46]. between the ages of 8 to 12 years to gauge their interests and Embedding narratives into behavioral change AVGs could preferences [62]. potentially promote the development of autonomous motivation Our key research questions include: Which of the four narratives to complete the game and adopt the behavior promoted in the would children consider to be the best for motivating them to game [37]. exercise so that we can develop the narratives further to motivate their long-term MVPA? What are the perceived narrative Children’s Narrative Preferences Across Media characteristics that help children to exercise versus Little is known about children’s game narrative preferences. characteristics to avoid? Most researchers to date have focused on print [47,48], with some later work conducted examining television [49,50]. Fiction Sampling and Study Population has been recognized as the most popular choice among We employed a nonprobabilistic, purposive sampling approach elementary school–aged children, with around 95% of them to recruit participants from a large, diverse, urban neighborhood reading it [51]. Children have also reported that fiction is easier in the United States. Many participants came from low-income and more fun to read than other types of stories [52]. Most households. The 8-to-12-year age group was targeted because children’s narrative fiction follows a linear path, with events children younger than 8 years have cognitive limitations in happening in chronological order [53]. This could be partially responding to survey questions [63] while children older than explained by the demand to meet children’s developmental 12 years have entered early adolescence and will be subject to needs so that they can understand the plot better. many physical, mental, emotional, and social changes that may As for the themes featured in children’s fiction, various scholars make their needs and responses different from those of younger have identified different methods to categorize genres. Across children [64]. In addition, without intervention, obese children genders, intermediate-grade children (aged 5 to 7 years) in this age group are highly likely to become obese young adults preferred mystery and adventure stories [54], but children aged [65]. 11 to 15 years like fantasy, magic, scary, sorcery, school, Since children of different weight statuses have different activity romance, and true story genres [55]. Indeed, these themes help patterns when playing the selected AVG [66], we recruited to open imaginary worlds for audiences to be transported to a approximately 20 children in each weight group (normal weight new place. vs overweight-obese) to detect potential differences in narrative Recent years have also seen a surge of discoveries about children preferences. Our expectation was that 20 children in each group and young adults’ interest in dystopian science fictions [56-58]. would be adequate to achieve theoretical saturation (ie, the point While this preference may be related to the contemporary world at which no new information is attained) [67]. and issues brought about by the industrial revolution and global Narrative Production capitalism, the thematic elements in these fictions may also We developed four narrative plots to accompany the selected appeal to children and adolescents because they offer strong Shape Up game, which requires players to participate in a series emotional stimuli and allow them to explore different identities of engaging workout exercise sessions involving kickboxing, during this particular developmental stage [59]. stomping, squatting, jumping, and so on. Players can see We attempt to fill gaps in understanding regarding narrative themselves during these exercise sessions thanks to the Kinect design for AVG. Specifically, we created four different game sensor. The narrative development process was based on our stories based on narrative and game research with children and previous research and experience with children’s narrative adolescents; 41 children between the ages of 8 and 12 years engagement [25]. For example, we paid special attention to individually provided feedback on each of the four narratives presenting and justifying the protagonist’s motivation to engage and selected their favorite. We adopted a transcendental in PA. Each story featured genres we believed to be appealing phenomenological approach, which aims to uncover the common to children (ie, adventure, mystery, science fiction, and meaning for multiple individuals of their narrative experience suspense). In accordance with the behavioral theories such as [60]. We then analyzed children’s responses in individual theory of planned behavior, social cognitive theory, and cognitive interviews using an exploratory thematic analysis self-determination theory, narratives were created with the goal methodology. of encouraging children to play the selected game with increased PA intensity and duration. Each video clip lasted between 3 and Methods 3.5 (mean 3.2) minutes, serving as a story teaser. All clips featured professional-quality animation art and voiceover with Project Description distinct styles, and all ended with a cliffhanger that dissolved This work is part of a larger project systematically exploring into a “To be continued...” screen. More specific details about the effect of narratives on children’s long-term MVPA through the plot, relevant theoretical concepts in narrative design, and AVG play. We created four professionally made narrative animation clips that convey information about different story http://games.jmir.org/2019/4/e16031/ JMIR Serious Games 2019 | vol. 7 | iss. 4 | e16031 | p. 3 (page number not for citation purposes) XSL FO RenderX JMIR SERIOUS GAMES Lu et al specific design strategies for each of the stories can be found • We had the main characters engage in various types of PA in Table 1. Overall design strategies included the following: and portrayed both the characters and PA as appealing and fun. • We ensured that exercise and physical activities are featured • We created character dialog and plots to elicit emotional throughout the four stories for observational learning while reactions and increased enjoyment from children. also integrating the physical activities with the narrative’s natural development. We also showed characters encountering and successfully overcoming PA challenges. Table 1. Narrative synopses and design strategies. Title Synopsis Specific design strategies Food Fight An adventure/quest fiction about two friends: Third-person perspective narration: female player character one of them is a gamer attracted to a mobile Main character gender: two girls game called “Food Fight.” She accidentally spills Main character traits: helpful, considerate, brave, humorous, courageous coffee on the other friend and her phone while No antagonist volunteering in a nursing home. As they are PA design: character must dodge food attacks (fun and exciting) and engage trying to dry their phones, an accidentally trig- in PA (jumping and running) to stay alive in game. The gamer character must gered cat-shaped timer sucks the coffee-covered figure out a way to rescue her friend from the game by engaging in all of these friend into the world of the mobile game and exercises turns her into a game character. Reward: gamer character receives rewards as she survives each level Modeling: characters demonstrate the exciting aspects of PA Engagement: friendly banter and the fantastical design of the hurdles during the gamified PA acts #PeepThisSheep A mystery/suspense fiction about a talented child Second-person perspective narration: Gender-neutral player character detective: the detective is lured from a party by Main character gender: one boy and “you” a secret note left by someone called “9.” The Main character traits: intelligent, warm-hearted, brave, spirited “9” character tries to recruit the child detective One antagonist: Cobalt, who wants world control to join a top spy agency because an evil person PA design: detective character suddenly realizes that the video was actually called Cobalt plans on launching a killer app to the killer mind-control app and must act fast through engaging in PA (running, dominate the world tomorrow evening. The fighting, and searching in an interactive and simulated virtual social network) agency needs the detective’s help. As the detec- before everything gets out of control tive is preparing to thwart Cobalt’s app launch, Social support: your teammates and your classmates a sheep video with a “PeepThisSheep” hashtag Engagement: player character addresses the children directly and encourages becomes wildly popular around the world. them to exercise and demonstrates that PA is easy and fun and necessary to save the world from the evil Cobalt Ataraxia A fantasy/science fiction with the backdrop of Second-person perspective narration: Gender-neutral player character a bleak future where a dictator rules the protag- Main character gender: a boy and a girl and “you” onist’s postapocalyptic country: the character’s Main character traits: courageous, nice, compassionate, adventurous mother adopted twin babies she found by the One antagonist: evil dictator roadside and raised them as her own. The family PA design: the evil dictator discovers this and abducts the twins so he can use later finds out that the twins do not feel pain and their genes to create a force of invincible super soldiers; the character must have the power to take pain away from others. stop him through various PA engagement (searching, jumping, running, and The family tries to hide this from the world to combat on a future planet) protect the twins, but because of the twins’ kind Modeling: the twins keep engaging in fun and exciting PA nature and natural inclination to help others, the Social support: the mother figure helps the twins and you to overcome hurdles word gets out. for PA Engagement: emotional connection with the twins as your “siblings” through vivid details Star Dust A mystery/suspense fiction: it begins with two Third-person perspective narration: male player character friends’ over-night field trip to an observatory Main character gender: a boy and a girl to watch a meteor shower with their classmates Main character traits: resourceful, fearless, smart, quick-witted and parents, where an eccentric professor greets One antagonist: a scientist who keeps the remedy to the alien matter away them. The protagonist discovers an ancient from everyone prophecy while inside the observatory: the mete- PA design: character must figure out how to deal with those who are affected or shower will bring alien matter and wipe out and save the world through engaging in various PA behaviors (dodging infected the human race. When the shower begins, every- people, investigating the environment, and searching for a remedy to the alien one outside starts to behave erratically. matter) Engagement: player character needs to solve many puzzles to find out how to save the best friend who may have been infected by the scientist by overcoming many hurdles on the quest PA: physical activity. http://games.jmir.org/2019/4/e16031/ JMIR Serious Games 2019 | vol. 7 | iss. 4 | e16031 | p. 4 (page number not for citation purposes) XSL FO RenderX JMIR SERIOUS GAMES Lu et al • If you were the writer, would you make any changes to the Data Collection and Analysis story? Ethical approval was obtained from the Northeastern University • Now let’s talk about the characters. What did you think institutional review board. We obtained written informed about the characters? consent (from parents or guardians) and assent (from children) • Which of these characters might be able to help you move from all participants. Data were collected between October 2016 around and be more active? and March 2017 at a local community center for families. Demographic information was collected from parents or Follow-up questions were asked only if a participant’s response guardians. to the initial question did not cover specific topics of interest. Three research assistants included undergraduate and graduate The four narratives were shown to each child in a random students majoring in psychology, public health, and sequence on a laptop to minimize order effects. After each child communication. Each of them received 25 to 30 hours of viewed each of the four narratives and completed the cognitive extensive training in cognitive interview techniques prior to interviews, the assistants gave them four photo cards (Figure data collection. They used an interview protocol consisting of 1) showing the title and a screenshot of each narrative and asked 5 structured demographic questions, followed by 8 open-ended each participant to rank the narratives from most favorite to cognitive interview questions, and four open-ended follow-up least favorite by arranging the cards on a table. The assistants questions for each narrative. Interview questions were as documented each child’s narrative rankings (1=most favorite; follows: 4=least favorite) and then asked them the reasons for their rankings. Children were allowed to take a 5-minute break • Tell me what happened in the story? between each story interview, although few did due to their • What do you think happens next? enthusiasm about the animated narratives. Sessions lasted • How do you think the story will end? between 50 and 64 minutes. All children answered all questions. • What did you think about the story? Each child received a $25 gift card and they were entered into • Was there anything about the story that was hard to a drawing to win an OgoDisk set (OgoSport LLC). understand? Figure 1. Picture Cards for Narratives. http://games.jmir.org/2019/4/e16031/ JMIR Serious Games 2019 | vol. 7 | iss. 4 | e16031 | p. 5 (page number not for citation purposes) XSL FO RenderX JMIR SERIOUS GAMES Lu et al The inclusion criteria were between ages 8 and 12 years; able grouped and assigned an emergent code (eg, positive to speak English; and no visual, intellectual, or characteristics of a character) [70]. We organized and grouped neurodevelopmental conditions (eg, autism, anxiety disorders). the codes for each question into higher order codes and then All interviews were conducted in English and digitally recorded. into themes using an open-coding process. The themes were Verbatim responses were transcribed by a professional arranged into two categories: features that motivate children to transcription agency. We then compared the transcripts to exercise versus features that discourage them from exercising. recordings for accuracy and revised the transcripts when This strategy was applied to transcripts for all narratives. The necessary. To minimize the likelihood of unintentional bias, coding team met weekly over 3 months with the first author to three coders (undergraduate and graduate students majoring in discuss the codes and organize them into themes within each public health and communication) independently analyzed the category. We achieved a general consensus for each category transcripts [68]. Coders received around 35 to 40 hours of over the meetings and observed theoretical saturation across training for coding qualitative data and cognitive interviews as the interviews. part of the process of sensitizing concepts [69]. They read each of the 41 transcripts multiple times before the coding process Results began. Participant Characteristics Coding used a hybrid thematic analytic approach. A structured The two weight groups were comparable in multiple approach was initially used with interview questions providing characteristics (Table 2). Children of both groups had a moderate the framework. Within each question, similar answers were degree of experience in playing Kinect games. http://games.jmir.org/2019/4/e16031/ JMIR Serious Games 2019 | vol. 7 | iss. 4 | e16031 | p. 6 (page number not for citation purposes) XSL FO RenderX JMIR SERIOUS GAMES Lu et al Table 2. Children’s demographic information (N=41). Characteristic Normal weight n=21 Overweight-obese n=20 P value Age in years, mean (SD) 10 (1.6) 10.9 (1.4) .51 Gender — .26 Boy 10 13 — Girl 11 7 — a 2 17 (1.9) 25.8 (3.3) .01 BMI , kg/m (SD) BMI, percentile (SD) 49.7 (26.7) 96.3 (2.1) .01 Race, n (%) — — .67 African American 10 (48) 7 (35) — American Indian/Alaska Native 2 (10) 1 (5) — Asian 1 (5) 2 (10) — Caucasian 5 (24) 5 (25) — Other (mixed) 3 (14) 5 (25) — Parent education, n (%) — — .31 High school 5 (24) 1 (5) — Technical school 1 (5) 2 (10) — Some college 2 (10) 4 (20) — College graduate 4 (19) 8 (40) — Postgraduate Study 9 (43) 5 (25) — — — .76 Annual household income (US $) , n (%) <$20,000 6 (29) 4 (21) — $20,000-$39,999 5 (24) 7 (37) — $40,000-$59,999 1 (5) 1 (5) — $60,000-$79,999 3 (14) 3 (16) — $80,000-$99,999 4 (19) 1 (5) — >$100,000 2 (10) 3 (16) — Kinect games (KG) experience — — — How much have you played KG? (1=a little; 5=a l lot) 2 (1.5) 2.6 (1.3) .15 How familiar are you with KG? (1=unfamiliar; 5=familiar) 2.3 (1.4) 2.7 (1.6) .61 BMI: body mass index. Not Applicable One family of an overweight-obese child did not provide an answer to this question. Thus, n=19. have been kidnapped by an evil dictator to create an army of Narrative Preferences indestructible soldiers. In addition, the interview transcripts We calculated the preference score distribution and average indicated children’s negative comments and criticisms were the rank score for each narrative. A lower score indicates higher shortest for Ataraxia compared to the other three options. In preference (eg, the favorite story was ranked 1 most favorite, general, we did not observe differences across the weight, second favorite as 2, and so on). Ataraxia was the top-rated gender, and racial groups in responses to the narratives; story overall and among all weight, gender, and racial groups. therefore, the ratings of each story were collapsed across all The story takes place in a dystopian future, when a twin brother groups (Table 3). and sister with the ability to absorb and take away people’s pain http://games.jmir.org/2019/4/e16031/ JMIR Serious Games 2019 | vol. 7 | iss. 4 | e16031 | p. 7 (page number not for citation purposes) XSL FO RenderX JMIR SERIOUS GAMES Lu et al Table 3. Children’s narrative preferences. Title 1 (most favorite) 2 3 4 (least favorite) Average Ataraxia 14 16 9 2 1.98 Food Fight 11 5 15 10 2.59 Star Dust 7 11 13 10 2.63 #PeepThisSheep 9 9 4 19 2.80 They could probably teach me how to be more active Thematic Analyses and teach me how to be generous that they were in The cognitive interview analyses provided rich insights the story. [Child 67] regarding key characteristics of stories (eg, characters and plot) To a certain extent, likeable characters also make social children found effective versus ineffective for motivating them cognitive theory’s observational learning more likely to happen to exercise. Analyses included comments regarding children’s when children identify with the credible characters perceived evaluative responses (cognitive and affective) to other narrative to have good moral qualities. Similarly, according to characteristics related to our research questions. In comparing self-determination theory, which specifies the basic feedback, few differences were observed among children of psychological needs for relatedness to be one of the key both weight groups. Therefore, their responses were combined. precursors for autonomous motivation and engagement, To maintain confidentiality, participant quotes are identified characters perceived to have good moral qualities would foster with a randomly generated number between 0 and 300. relatedness by bring children closer to the character who engages Responses to the Favorite Narrative in PA. Additionally, such qualities would help to enhance children’s emotional engagement and connections with the Ataraxia, a science fiction story set in the dystopian future, was characters, thus potentially enhancing immersion. selected as the favorite narrative among all weight, gender, and race groups. Most of the themes identified to motivate children Last, some overweight-obese children and a few normal weight to exercise can be found from children’s response to this story. children mentioned that the twins have special abilities that Therefore, they are mentioned here in the order of the frequency enable them not to feel pain, which is desirable for exercise. observed with a special emphasis on Ataraxia. More specifically, ...so if you get hurt then you can still run around. the themes revolved around protagonists, character attributes, [Child 163] and story elements in the order of their observed weight. In the next section, after illustrating the themes with quotes, we This is a notable example of narrative’s power to enhance connected findings with relevant concepts from health behavior perceived behavioral control, another key influencer of the and media psychological theories. behavioral intention, which determines behavior according to theory of planned behavior. Enhanced perceived behavioral Almost all children identified the twins (ie, the protagonists) as control could also potentially increase children’s self-efficacy, appealing protagonists who would motivate them to exercise. or confidence in performing a particular behavior according to The primary reason usually mentioned was that the activities social cognitive theory. The self-efficacy increase could occur the twins were performing (eg, leaping from roofs, running after through observational learning or modeling of characters. In wild boars, or playing with nests of hornets) were fun and addition, self-efficacy can also be enhanced through character exciting. identification, when children put themselves into the character’s I think I might want to join them because it looked a shoes. This could help children overcome fear of discomfort in little bit fun. [Child 83] performing PA and increase their confidence when they start identifying with the twin characters. Interestingly, quite a few The children seemed to have a positive attitude toward PA, responses suggested strong parasocial interaction [72] with the which is a crucial determinant of the PA behavioral intention, twins. the strongest predictor of PA behavior according to the theory of planned behavior. This also echoes social cognitive theory’s ...If I was playing with them...like hanging out with emphasis on observational learning via role models and them... [Child 97] self-determination theory’s emphasis on enjoyment in ...If they were my friends, they’d be like cool people intrinsically motivating children to engage in PA. to hang out with. [ Child 292] The second theme was that the characters had good moral These coincided with the positive role model effect and potential qualities, which echoes the findings that audiences tend to emotional affinity and engagement (ie, connection) with the engage with moral characters [71]. characters. According to self-determination theory, these are Both of them were really brave and really courageous important factors helping children to develop autonomous because not only they stayed in the house, but they motivation for PA behaviors. jumped over...from house to house. [Child 217] Aside from the twins, other characters also played a role in motivating the participants to exercise. For example, the mother http://games.jmir.org/2019/4/e16031/ JMIR Serious Games 2019 | vol. 7 | iss. 4 | e16031 | p. 8 (page number not for citation purposes) XSL FO RenderX JMIR SERIOUS GAMES Lu et al “...seems very nice and she seems like she could give me some Both children’s affinity for detail and need for additional story confidence” [Child 211]. development also suggested their high level of narrative involvement with Ataraxia [73], which could potentially lead It seems that the mother character had a positive effect on the to increased PA later. subjective norms (ie, children’s beliefs about how people they care about would view their PA behavior according to theory Responses to the Remaining Narratives of planned behavior). The mother character’s encouraging Additional themes were identified from the other three narratives gestures and actions would also potentially increase the to explain why the children did not find them as effective children’s self-efficacy in PA engagement. The character “I,” exercise motivators. While in general children liked the art who was not shown in the narrative directly, could enhance PA styles and plots of these narratives, many used “boring” to motivation as evidenced by “I get jealous of the video game describe the characters and plots in the remaining narratives. characters, that they get to do all this running around” [Child Some meaningful patterns emerged when we further examined 212] or because I want to be “try[ing] to get [my] [family] back” their comments. The results are also focused on protagonists, [Child 161], all of which suggested potential emotional character attributes, and story elements. engagement. First, there was a lack of interesting or exciting action, which Interestingly, opinion about the antagonist (evil dictator) was might make the protagonist less attractive. For example, when split. While some considered him as a character who would talking about Food Fight, one child commented, “I think it’s help them to exercise, the action was more of “run[ning] away boring because, well the character didn’t actually fight in the from him” [Child 158] than running along with him. Many game” [Child 5]. Another said that “It’s like—it needs more others did not consider an evil character to be trustworthy or action” [Child 239]. The same thought was mentioned for motivational. #PeepThisSheep as well, “[Be]cause it doesn’t have that much action” [Child 271]. Similarly, another child mentioned that the If this guy is secretly a super villain who wants some reason Star Dust was not ranked higher because “...[w]alking, mindless soldiers, I don’t think a lot of people would running. It’s all they do” [Child 193]. From a theory of planned be wanting to do what he does. [Child 2] behavior framework, these narratives did not seem to help with These responses suggested the importance of positive and the participants’ subjective norms by showing PA behaviors as engaging narrative character creation, as character with negative part of the desired action constantly performed by the characters. qualities may not be as effective at motivating children to The narratives failed to provide accessible and attractive perform the desired PA behaviors. behavioral models for children to learn through observation of the character actions according to social cognitive theory. These Another theme identified was the story’s immersive issues may lead to the failure to instigate autonomous motivation characteristics. from children, let alone enjoyment, both of which are important You can join the story... That would be cool...[and] in instigating PA behaviors according to self-determination you are part of the story. [Child 5] theory. I liked how you were so...like you in the story. [Child Second, lack of details about characters and plots seemed to 8] have prevented children from fully understanding and appreciating the narrative developments. For example, when I was really intrigued and everything. When it said talking about #PeepThisSheep, a child said that the narrative they [the twins] were gone, I was just like, “Don’t “did not have that much details in it...for [the child] to end, don’t end, don’t end,” and then it ended. [Child understand what that means” [Child 216]. Another mentioned 44] adding a bit information to the antagonist. Many children used the words “interesting,” “cool,” “fun,” and Maybe just [like] give a little back story on why she “creative” to describe their overall impression of the narrative. wants to release this Peep this Sheep on social media. Children also appreciated the amount of detail and explanations [Child 2] offered throughout the plotline. Similarly, another child suggested offering additional I think that’s a good thing because there was lots of information for how the character in Food Fight was stuck in like plot into the story and lots of details, so I think the phone. that was good. [Child 103] They could give a whole explanation of how she got [Be]cause it gave reasons for everything...because it stuck in the phone. [Child 162] explained everything. [Child 162] While the exact causal relationship between details and narrative They also expressed their desire to continue following the story engagement needs additional exploration from an development. interdisciplinary angle, children’s complaints about the lack of Yeah. I like things that will continue in series. It’ll narrative detail suggested their lower level of character keep on going and going and going until like the very appreciation and narrative engagement, which could be less last. [Child 194] likely translated into PA motivation. http://games.jmir.org/2019/4/e16031/ JMIR Serious Games 2019 | vol. 7 | iss. 4 | e16031 | p. 9 (page number not for citation purposes) XSL FO RenderX JMIR SERIOUS GAMES Lu et al Third, the narrative motifs were perceived to rely on common Well, [what] I don’t get the plan is why “9” would or overused literary tropes, which might make the plot less be stalking you instead of [Cobalt]. [Child 161] interesting. For example, when one child described Star Dust, Accordingly, they questioned the subsequent plot development. they said: It was kind of hard to understand how “9” is a Because it was boring. How like—they just go on a stranger to the narrator and then like [the narrator] camping trip. And then everything just goes bad. And just ends up going to his basement and...joining...his like everybody just starts turning evil. I feel like that’s spy team. [Child 167] what happens in most stories. [Child 156] Another described Food Fight by saying: Discussion I’m not saying that Food Fight is bad or anything; Practical Recomendations it’s just that it could have...been a little bit more Based on the exploratory thematic analysis, we arranged the creative. [ Child 2] two themes identified (features that motivate children to exercise Similarly, when describing Cobalt, the antagonist from vs features that discourage them to exercise) into preliminary #PeepThisSheep, one child said: creative design principles. The principles are presented as Dos and Don’ts for narrative creation intended to motivate children Cobalt seems like a character I’ve seen before inside to participate in physical activities. The theoretical implications a movie. [Child 96] are also discussed. Please note that given the limited sample These responses suggested repeated narrative tropes may not size and research strategy, all of the recommendations are bring about the optimal engagement from children to attend to presented more as exploratory possibilities that need to be the story development, let alone participate in PA. empirically verified. In addition, children seemed to take it for granted that there Dos should be a bad guy (antagonist) in the story. Do Create Child Characters With Strong Moral Values I like that there’s a video and everybody likes to watch Children identify with and want to model themselves after it, so a bad guy could hatch a plan. [Child 163, characters who are good people and who are like them. Both #PeepThisSheep] tendencies have been well documented by social learning theory Cause he’s a scientist and knows about like a lot of and affective disposition theory researchers [74,75]. While truly stuff and then he’s so evil, but I think evil’s pretty bad characters are also needed as antagonists, they may motivate cool. [Child 96, Star Dust] children to be physically active but in a more passive way. For example, the children can escape when the bad guys are Because like if a story doesn’t have a bad guy, then threatening their lives. On the other hand, children do not want it’s just going to be boring. [Child 156, Ataraxia] to see the protagonists fight against each other. On the other hand, as Food Fight did not feature a true antagonist Do Involve Extraordinary Actions and shifted the conflicts among the two friends, it did not seem Designers should create narratives with characters in constant to work for motivating children to exercise. need of action throughout, or in other words, action-packed I have a best friend and me and her, we don’t get into narratives. The actions should not be regular mundane routines like fights a lot because we know it was gonna ruin (eg, walking or running) but something unusual. This concept our friendship together [Child 83] is closely related to the interactive nature of active games and will also cater well to children’s novelty-seeking tendency in Because it’s better to say sorry than just get mad at their developmental stage to capture and sustain their attention your friends. [Child 173] to the story development. These responses emphasize the importance of creating Do Make the Desired Exercise Fun, Interesting, and interesting antagonists with depth and dimension to maintain Integrated Into the Story children’s interest. Excitement is crucial for inciting children to imitate characters’ Last, children did not particularly enjoy the spy-themed plot in actions and ultimately initiate their own PA. Fun and interesting #PeepThisSheep. More specifically, they seemed to be bothered exercise makes PA more desirable and less tedious [76]. When by how the main character was approached and recruited by excitement, fun, and interesting exercise are packaged within “9,” who lured the main character out of a school party with a an active game, children will more likely be intrinsically favorite snack and left a secret note. Quite a few children seemed motivated to exercise over time [77]. to be irritated by his actions. Do Involve Super Powers When Creating Protagonists and “9” was so secretive; he was kind of creepy. [Child Plots 8] Fantasies and fictions open up imaginary worlds, enabling Others equated his behavior to that of the antagonist. children to be transported to the narrative world [78]. Super powers not only could make the physical activities engaging http://games.jmir.org/2019/4/e16031/ JMIR Serious Games 2019 | vol. 7 | iss. 4 | e16031 | p. 10 (page number not for citation purposes) XSL FO RenderX JMIR SERIOUS GAMES Lu et al and exciting but also may potentially help remove perceived needed to discover if narratives produced with these features in obstacles for children who are not used to exercise and who mind would indeed lead children to actually play more AVGs. would not want to exercise, to increase their self-efficacy. Additionally, the long-term effect of the narrative’s motivation should be validated by children’s play behavior over time. We Do Create Immersive Story Plots With Intriguing only used one story from each genre, and it may be hard to Cliffhangers pinpoint why exactly children preferred one story over the others The power of the immersive narrative engagement has been due to the different characteristics of the four stories. The discussed extensively [79]. In addition, suspense is a frequently animated narratives were not integrated into the game, Shape employed device for maintaining audience interest in stories Up, during this round of data collection, and children did not [80]. Intriguing cliff hangers delivered at the right moment may have the opportunity to play the games after they viewed the make children curious about what happens next [81]. They will videos. Additional studies are needed to explore whether be eager to continue their narrative engagement through integration of Ataraxia into Shape Up gameplay would motivate additional exercise behaviors. children to exercise. Another limitation is that we have a relatively small sample size and only conducted this study in Don’ts one area of the country; recruited children across many weight, Don’t Omit Information From the Story Development gender, and racial groups from low-income households; and focused primarily on game narrative development, all of which To ensure that the narratives are organically related to physical would limit the generalizability of our findings. In other words, activities, relevant information about why the character is while we did not observe differences across the groups, we want engaging in PA should be integrated into the story development. to add the caveat that the subgroups were relatively small and This will help to justify character’s motivation to engage in could limit our capacity to detect group difference. All of different types of exercises as a natural progression of plot participants, however, seemed eager to participate in such development, thus making character actions believable and projects and were able to provide insightful responses. Last, we improving the players’ intrinsic motivation to participate in only had one narrative for each genre, which could serve as a physical activities. confounder. It is difficult to tease apart whether the design Don’t Forget to Provide Reasonable Explanations (With strategy or the theme of each narrative was the actual reason Details) for Why Things Happen for children’s preference. It would be ideal if two or more While adults may make the mental bridges as part of their variations of the narratives within the same theme could be sense-making process to understand and process narratives, the designed and tested with children [85]. extra effort required may be taxing for children [82] and may Conclusion reduce their narrative engagement. It is important to assess if a narrative has a well-balanced portion of information given and Narratives have immense potential for promoting PA among withheld from children so that their interest in the characters children through AVGs, but less is known about active game and plot can be constantly piqued but not burdened with too narrative development. Our work here serves as one of the first many questions along the way. steps toward a series of systematic inquiries into how to maximize the behavioral potential of narratives for combating Don’t Put Protagonists in a Passive Situation to Be Tricked childhood obesity. We tried to incorporate existing or Watched interdisciplinary psychological and behavioral theories into the An important feature of interactive games is that the players are narrative development and used direct feedback from our allowed to be active agents making interactive exchanges within participants to further inform our narrative development process. the game to make progress [83]. As a result, while it is A clinically relevant age group (8 to 12 years) was chosen for reasonable to have some obstacles for the protagonists during this project because they are most at risk and closely related to the narrative, they should still be given a moderate amount of the obesity issue and the age group would be a proper range to agency to be in charge of their fate. Putting them in a passive intervene. Given the unique persuasive power of narratives, it situation (eg, being stalked or watched) may reduce children’s is also likely that a story developed with this age group in mind motivation to engage in PA. would be mostly likely influential among the children. We Don’t Make Boring Stories With a Lot of Ordinary Events believe this kind of process will help to create an iterative design or Actions methodology for the development of child-friendly narratives Children are savvy media consumers [84]. Narrative creators that are effective in motivating PA in the future. should not underestimate their expectation of innovative stories From a theoretical perspective, we tried to integrate multiple with unpredictable endings. In addition, they want their concepts from behavioral theories (theory of planned behavior, imagination to be their guide as they are transported into a social cognitive theory, self-determination theory, etc) and fantastical new world instead of getting trapped in the ordinary media psychology (identification, interpersonal attraction, daily routines. parasocial interaction, etc) into the narrative development stage (see Table 1 for details) and later explored their engagement Limitations effect through a close analysis of children’s feedback in the A limitation of this study is that we relied exclusively on result section. Children seemed to be attracted to positive role self-report interview responses instead of measuring children’s models who are engaged in unique forms of PA. Such role actual PA behavior in real-world settings. Further studies are http://games.jmir.org/2019/4/e16031/ JMIR Serious Games 2019 | vol. 7 | iss. 4 | e16031 | p. 11 (page number not for citation purposes) XSL FO RenderX JMIR SERIOUS GAMES Lu et al models increased their narrative involvement and, to some games. Appealing features include positive characters, extent, their self-efficacy. Children also highlighted the way extraordinary actions, interesting plots, super powers, as well the narratives created autonomous motivation (eg, wanting to as engaging cliffhangers, all of which should be aligned with be like the characters or spend time with the characters) and the exercise motivation. On the other hand, mentally taxing, increased their subjective norms (eg, important characters passive protagonists devoid of agency and hackneyed narrative encouraging them to exercise). tropes should be avoided. Future work is needed to verify these findings and examine their effect of PA during gameplay. This research provides preliminary evidence that narratives have characteristics which may increase child PA when playing active Acknowledgments The authors thank Malcolm Matheson, Jessica Peck, Elise Krims, Lin Qi, Tom Culman, and Andrés Hoyos-Céspedes for their help with data collection and analysis. This project was supported by ASL in part by a grant from the National Institute of Diabetes and Digestive and Kidney Diseases (1R01DK109316). FableVision Studios produced the four animated narratives. Conflicts of Interest None declared. References 1. Warren M, Beck S, Rayburn J. Trust for America's Health (TFAH) and Robert Wood Johnson Foundation. 2018. State of obesity: better policies for a healthier America URL: https://www.tfah.org/wp-content/uploads/2018/09/ TFAH-2018-ObesityReport-FINAL.pdf [accessed 2019-10-19] 2. World Health Organization. 2018. Obesity and overweight URL: https://www.who.int/news-room/fact-sheets/detail/ obesity-and-overweight [accessed 2019-07-26] 3. 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'Generation Z' children's adaptation to digital consumer culture: A critical literature review. J. Cust. Behav 2014 Aug 25;13(2):113-133. [doi: 10.1362/147539214X14024779483591] 85. Wolfe CR, Dandignac M, Reyna VF. A theoretically motivated method for automatically evaluating texts for gist inferences. Behav Res Methods 2019 Jul 24. [doi: 10.3758/s13428-019-01284-4] [Medline: 31342470] Abbreviations AVG: active video game MVPA: moderate to vigorous physical activity PA: physical activity Edited by G Eysenbach; submitted 27.08.19; peer-reviewed by P Kreniske, D Hu; comments to author 18.09.19; revised version received 23.09.19; accepted 17.10.19; published 21.11.19 Please cite as: Lu AS, Green MC, Thompson D JMIR Serious Games 2019;7(4):e16031 URL: http://games.jmir.org/2019/4/e16031/ doi: 10.2196/16031 PMID: 31750833 ©Amy Shirong Lu, Melanie C Green, Debbe Thompson. Originally published in JMIR Serious Games (http://games.jmir.org), 21.11.2019. 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/2019/4/e16031/ JMIR Serious Games 2019 | vol. 7 | iss. 4 | e16031 | p. 15 (page number not for citation purposes) XSL FO RenderX
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JMIR Serious Games – JMIR Publications
Published: Nov 21, 2019
Keywords: narrative; physical activity; active game; children; thematic analysis