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CS499R/PSYCH482/CS798 | Games for Health Winter 2016
(Limited-Enrolment: By Permission Only)
***LAST UPDATED MARCH 6 (Duedates updated)***

Organizational Meeting/Session 1
Friday January 15, 2016, 12:00-1:30, Davis Centre 1316

Course Coordinator

Course Description

CS499R/PSYCH482/CS798 Games for Health is a reading seminar and game design course that will review the current major applications of games in healthcare. Readings will cover the major fields in healthcare where games are being used. Case studies will survey a representative set of current health-related games, from best-practices to examples indicating just how far this field has yet to develop.

Special Themes

The special themes for this offering of the course will be:

Course Objectives

By the end of this course students should have a good understanding of the current major topic areas for health-related games, an appreciation for what makes for good "gamification" in healthcare, and the ability to apply good game design principles in healthcare applications.

Recommended Background

There are no formal requirements other than interest in the topic and ability to read and analyze technical material. Some pre-existing knowledge of popular video games would be helpful but is not necessary. Background in other relevant fields (e.g., psychology, health sciences, narrative modeling) will also be useful.

A project team may choose to extend their digital game prototype towards a working implementation for their own interest but no programming is required in the course. Full marks may be obtained for a card game, board game, or other paper prototype of a game. Ideally, Computer Science and students from other disciplines will participate as members of a team.


Grading Breakdown

Project Guidelines and Course Administrivia



All readings will be made available from this website, or either in hardcopy or electronic versions from University of Waterloo Library Course Reserves or e-journals.


To find the location of a reading, go to the course reserves link on the University of Waterloo's Library web page at:

When you choose your course (CS499R, PSYCH482, CS798) you will see a list of the titles on reserve. Electronic content can be accessed from anywhere with an Internet connection.

Jane McGonigal
Reality is broken: Why games make us better and how they can change the world
Penguin Books, 2011  

S. Arnab, I. Dunwell, and K. Debattista (editors)
Serious games for healthcare: Applications and implications
IGI Global, 2013  

K. Bredl and W. Bosche (editors)
Serious games and virtual worlds in education, professional development, and healthcare IGI Global, 2013  

B. Schouten, S. Fedtke, T. Bekker, M. Schijven, and A. Gekker (editors)
Games for health: Proceedings of the Third European Conference on Gaming and Playful Interaction in Health Care
Springer, 2013  

References on Game Design

Jesse Schell
The art of game design: A book of lenses
CRC Press, second edition, 2015  

Jesse Schell
The art of game design: A deck of lenses
Schell Games, second edition, 2014
(cards to accompany the book)  

Other Resources

Games for Health Conference

Game Developers Conference

Serious Play Conference

Jane McGonigal's website:

Course Outline

Session 1: Organizational Meeting/What is a (Serious) Game?

Friday January 15 12:00-1:30 DC1316

Getting Started with an Overview

Games in real life?

The current state of health gaming

Administrivia slides


Background reading

Bill Ferguson, "Videogames: The good, the bad, and the ugly",
Games for Health Journal, February 2013, 2(1): 1-2

Jane McGonigal
Reality is broken: Why games make us better and how they can change the world
Penguin Books, 2011
Chapters 1, 14, Conclusion

Session 1 slides


Case studies

Quest to Learn: The world's first game-based public school

Top Secret Dance Off: Unlocking the secret power of dance

Free Rice: A crowdsourcing game to combat world hunger

World Without Oil: A massively collaborative imagining of a global oil crisis

Fold It!: Solving protein-folding puzzles

EyeWire: A game to map the brain
About EyeWire:

Where to sign up to play the game:

MalariaSpot: Building a global network of virtual malaria hunters through gameplay

Demo and TED talk:

Play the game:

Game available: Android, PC, iPhone

Miguel Angel Luengo-Oroz, Assier Arranz, and John Frean, "Crowdsourcing malaria parasite quantification: An online game for analyzing images of infected thick blood smears", Journal of Medical Internet Research, 2012;14(6):e167

Available from University of Waterloo Library e-journals

From 2013 Games for Health Conference,
Speaker: Miguel A. Luengo-Oroz, MalariaSpot Founder

"According to the World Health Organization, approximately 216 million cases of malaria occur in the world each year, and the disease kills about 655,000 people annually....Currently, the gold standard for malaria diagnosis worldwide consists of first detecting parasites, and then counting the number of parasites in blood smears by using a microscope....An average of 100 images have to be visually checked by a specialist, a process that can take up to 30 minutes. Confirmation of a negative diagnosis is ultimately dependent on the technician’s expertise....

Thus, we need scalable, fast, ubiquitous, and accurate screening systems...Mobile phone coverage is reaching every corner of the planet and we see the global connectivity as an opportunity to distribute the images all over the Internet.

We believe that there is so much online talent out there that can be used to analyze malaria images (while you play a game!)..."

Session 2: Games versus Gamification/Past Projects Review

Friday January 22 12:00-1:30 C1316

Thoughts from Games & Gamification Session, 2014 Games for Health Conference,
Speaker: John Ferrara:

"...Too often, people say gamification when they mean games, and sometimes people say games, when they mean the simplicity of gamification. Most often, people are literally confused, thinking that these two words, and their associated practices and traits are one-in-the-same.

Well they’re not.

...the true health experience designer sees games and gamification as mutually inclusive...A common source of trouble on pure gamification implementations is that people often define the experience very narrowly, sacrificing the fundamental appeal that draws people to games in the first place. A broader approach to design, still connected to some of the strengths gamification makes appealing, can lead to better outcomes...[this] session seeks to get at the bigger issue at play when defining experiences as being games or gamified. That issue, simply put, is what works for the user and why?"

Games versus Gamification

Videos and Group Discussion

Review of "Games for Health" Course Projects

Spring 2014 projects: Games for various health topics (e.g., nutrition, exercise, mental health, rehabilitation)

Fall 2015 projects: Games for mental health for high school and first-year university students

Session 3: Board and Card Games/Workshop 1

Friday January 29, 12:00-1:30, DC1316

Workshop 1: Brainstorming on Project Game Concepts

Objective: One-page project proposal (due next week)

Papers and case study

POX: A public health game

Game available:
Both board and digital versions are available from the course coordinator.

Geoff Kaufman and Mary Flanagan, "Lost in translation: Comparing the impact of an analog and digital version of a public health game on players’ perceptions, attitudes, and cognitions", International Journal of Games and Computer Mediated Simulations, 5(3), 2013, 1-9
Available at:


Flanagan, M., Seidman, M., Belman, J., Punjasthitkul, S., Downs, Z., Ayoob, M., Driscoll, A., and Downs, M., "Preventing a POX among the people? A design case study of a public health game", Proceedings of DiGRA 2011 Conference: Think Design Play, Hilversum, Netherlands
Available at:

Presenters: Chantelle, Samantha

Case study

Monster Appetite


Presenters: Salman

From 2013 Games for Health Conference:

"Monster Appetite addresses the obesity epidemic, one of America’s largest public health challenges, now growing in the rest of the world. In light of efforts to combat the obesity epidemic, Monster Appetite is a game that potentially remediates some aspects of the concern by promoting awareness of the content of food typically consumed by children."

Session 4: Exergaming

Monday February 8, 12:00-2:00, DC1316 ***NOTE: DATE CHANGE***

Background reading

Paper (Historical Review)

Ian Bogost, "The rhetoric of exergaming"

Papers (Exercise)

Traditional game rewards:
Elizabeth J. Lyons, "Cultivating engagement and enjoyment in exergames using feedback, challenge, and rewards", Games for Health Journal, February 2015, 4(1): 12-18

Presenters: Hengzhi

Social exergaming:
Deborah L. Feltz, Samuel T. Forlenza, Brian Winn, Norbert L. Kerr, "Cyber buddy is better than no buddy: A test of the Köhler motivation effect in exergames", Games for Health Journal, April 2014, 3(2): 98-105

Arwen M. Marker, Amanda E. Staiano, "Better together: Outcomes of cooperation versus competition in social exergaming", Games for Health Journal, February 2015, 4(1): 25-30

Presenters: TBA

Bredl and Bosche, Chapter 1, "Concepts behind serious games and computer-based trainings in health care: Immersion, presence, flow"

Presenters: Ricky

Case studies: Comparing Fitbit to Zombies, Run!


Game available: App Store, Google Play, Windows Store (Fitbit wristbands available from course coordinator)

Testers/Presenters: Samantha, Hengzhi

Zombies, Run!

Game available: App Store and Google Play

Testers/Presenters: Chantelle, Salman

Session 5: Cognitive and Mental Health

Friday February 12, 12:00-2:00, DC1316

Background reading

Schouten et al., "A taxonomy of serious games for dementia", pp219-232

Kelli N. Dunlap, "Integration of game design and theory into group psychotherapy with veterans with severe/chronic mental illness", Games for Health Journal, April 2013, 2(2): 109-112

Case study


Game available: App Store (US), Google Play

Background reading

Ann Marie Roepke, Sara R. Jaffee, Olivia M. Riffle, Jane McGonigal, Rose Broome, Bez Maxwell, "Randomized controlled trial of SuperBetter, a smartphone-based/Internet-based self-help tool to reduce depressive symptoms", Games for Health Journal, June 2015, 4(3): 235-246


Presenters: Ahmad

Case study

Depression Quest

Follow the history at:

Game available: Steam

Presenters: Samantha

Case study

MoodHacker: A mobile app for depression self-management

Background reading

Presenters: Salman

From 2013 Games for Health Conference:

"...ORCAS [producer of MoodHacker] is applying gamification, personal user recommendations, and persuasive design to address challenges of user experience and engagement...The goal of ORCAS is to demonstrate long-term behavior change through evidence based outcomes. The result is improved health for individuals, which can drive down individual costs and costs to organizations when adopted by health care systems."


Session 6: Games for Children and Youth/Games for the Elderly

Friday February 26, 12:00-2:00, DC1316

Games for the Elderly


K. Gerling, I. Livingston, L. Nacke, and R. Mandryk, "Full-body motion-based game interaction for older adults", Proceedings of the SIGCHI Conference on Human Factors in Computer Science, 2012, 1873-1882

Available at:

Presenters: Hengzhi

Games for Children and Youth

Case study

PlayForward: Using Games to Improve Adolescent Health
Video: Google TechTalk, July 11, 2013

Presenters: General discussion



Meveshni Govender, Randy C. Bowen, Massiell L. German, Grzegorz Bulaj, Carol S. Bruggers, "Clinical and neurobiological perspectives of empowering pediatric cancer patients using videogames" Games for Health Journal, October 2015, 4(5), 362-374

Free-access available at:

Presenters: TBA

Paper and demos

Peter J. Chung, Douglas L. Vanderbilt, Neelkamal S. Soares, "Social behaviors and active videogame play in children with autism spectrum disorder", Games for Health Journal, June 2015, 4(3): 225-234

Presenters: Chantelle

Case study



Game available: Browser-based version currently available. Mobile version planned.

Presenters: Samantha

From 2014 Games for Health Conference,
Speaker: Jeff Orkin, Co-Founder, Giant Otter, Creator of "SchoolLife"

"SchoolLife is a social role-playing game that teaches and assesses social skills to combat the bullying epidemic....The technology platform underlying SchoolLife builds on over 10 years of research from the Harvard Graduate School of Education and the MIT Media Lab — research which has proven that walking in another’s shoes virtually improves relationships, and has demonstrated automating conversational characters with crowdsourced data."

Session 7: Narrative and Storytelling in Games I

Monday February 29, 3:00-5:00, DC1316

Friday March 4, 12:00-2:00, DC1316 ***NOTE DATE AND TIME CHANGE***


Amy Shirong Lu, "Narrative in exergames: Thoughts on procedure, mechanism, and others", Games for Health Journal, February 2015, 4(1): 19-24

Presenters: Ricky


Case study


Game available: App Store and Google Play

Presenters: Salman

From 2014 Games for Health Conference,
Miriam Verburg, Bloom Digital Media, Producer, "LongStory"
Elysse Zarek, Bloom Digital Media, Co-Producer, "LongStory"

"LongStory is a dating and adventure game that helps pre-teens sandbox healthy relationships and sexuality. It deals with issues such as consent, bullying, being different, fitting in and learning how to ask for what you really want.

LongStory has based its health strategy on encouraging players to develop empathy through a meaningful and challenging romantic storyline....Games can be interventions for mental health promotion, but the majority of mainstream games don't address the capacity to be emotional sandboxes in a meaningful way."

Case study

QuitIT: Teaching coping strategies for smoking cessation through interactive storytelling


Paul Krebs, Jack E. Burkhalter, Bert Snow, Jeff Fiske, and Jamie S. Ostroff, "Development and alpha testing of QuitIT: An interactive video game to enhance skills for coping with smoking urges", JMIR Research Protocols, Jul-Dec; 2(2), 2013

Published online Sept 11, 2013 at:

Presenters: Hengzhi

From 2013 Games for Health Conference,
Speaker: Jeff Fiske, Lead Designer,"QuitIT", Muzzy Lane Software

"For decades, the standard behavioral treatment for smoking urges has been behavioral rehearsal, which entails the identification, modeling, and role-playing of diverse cognitive and behavioral coping strategies to identify and manage smoking cues. This treatment promotes skill acquisition, bolsters confidence in coping with smoking cues, and reduces relapse to smoking."

In game vernacular, this skills acquisition approach is called “mastery” and is consistent with a gamer player’s experience as they advance through a variety of game genres such as Role Playing Games (RPGs)....Virtual reality games and simulations provide environments similar to those faced in the real world, which increases personal relevance and learning serve as powerful tools because they encompass many aspects of human learning, such as engagement, problem-solving, receiving corrective feedback, and repetition."

Session 8: Social and Virtual Reality Games

Monday March 7, 12:00-1:00, DC1316 ***NOTE DATE AND TIME CHANGE***

Papers and case study

Second Life: A 3D virtual world for eHealth

Presenters: Salman

Papers and case study

SimCoach/SimSensei: A virtual human support agent for PTSD


Short video overview:

CBC Radio Article and Audio Program (approx 30 minutes):

Albert Rizzo, Eric Forbell, Belinda Lange, John Galen Buckwalter, Josh Williams, Kenji Sagae, David Traum, "SimCoach: An online intelligent virtual agent system for breaking down barriers to care for service members and veterans", Chapter in Healing war trauma: A handbook of creative approaches, Routledge, 2012.

Available at:

Presenters: Ricky (papers, demos SimCoach, SimSensei)

Session 9: Workshop 2

Friday March 11 , 12:00-2:00, DC1316

Workshop 2: Drafting the Design Document

Objective: Individual feedback on features of your game prototype

***Draft Design Document due Friday March 18***

Session 10: Personalization in Games


Papers and case studies TBA

Session 11: Narrative and Storytelling II/Closing Discussion


Narrative and Storytelling in Games

Papers and case studies TBA

Closing Panel Discussion: Serious Games for Sensitive Subjects

Suggested background reading

Arnab et al., Chapter 5, "Ethics in the design of serious games for healthcare and medicine."

Bredl and Bosche, pp105-115, "Evaluation of serious games."

Schouten et al., pp75-84, "Servitization and commoditization: The business model dilemma confronting serious games for health."

Session 12: Class Project Poster Presentation


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