Exploring In-Game Reward Mechanisms in Diaquarium - A Serious Game for Children with Type 1 Diabetes

When developing serious games for health, the main goal is to use game mechanisms in a way that the users decide to extend their playing time, complete all levels within the game, and thereby gain progression and intended learning with regard to disease management. One major concern when developing games for health is, therefore, the possibility of users who withdraw from the game before completed. A game, with a rapid descending popularity and users quitting gameplay early, fails to provide medical education to patients and is thus useless. For that reason, motivational game elements, such as in-game rewards, have been heavily used when designing serious games. This paper identifies and suggests several reinforcement mechanisms within serious games and explores how they can be applied in diabetes. The game called Diaquarium, a serious game for children with Type 1 diabetes, provides knowledge regarding how nutrition, blood glucose levels, and insulin interplay for this patient group. A prototype has been developed to demonstrate its concept and some game mechanisms with help of Unity 3D game engine and the C# programming language. Game design, requirements and suggestions for the project, were gathered through literature review, attending workshops, meetings and discussions with experts, as well as feedback from a related user group through a questionnaire. The questionnaire was distributed to an elementary school class, involving nine 9-year-old children. The questionnaire examined and collected feedback regarding the game outline, usability, and preferred reward mechanisms in the Diaquarium game. Despite a short period of testing and a limited test group with non-diabetic children, the game was recognized as attractive and moderately difficult within the potential user group. The analysis suggests that rewards are highly a matter of preference. Simultaneously, there were indications that some of the rewards were more favorable than others. It appears that rewards serving a purpose within the game, e.g., potentially effect progression in the gameplay, are more favorable than the opposite rewards serving no purpose. The findings were highly valued and taken into consideration during the design process of exploring the in-game rewards of the Diaquarium.