JMIR Serious Games最新文献

{"title":"Playful Antisedentary Interactions for Online Meeting Scenarios: A Research Through Design Approach.","authors":"Jiaqi Jiang, Shanghao Li, Xian Li, Yingxin Xu, Jian Zhao, Pengcheng An","doi":"10.2196/62778","DOIUrl":"https://doi.org/10.2196/62778","url":null,"abstract":"<p><strong>Background: </strong>Online meetings have become an integral part of daily life for many people. However, prolonged periods of sitting still in front of screens can lead to significant, long-term health risks. While previous studies have explored various interventions to address sedentary lifestyles, few have specifically focused on mitigating sedentary behavior during online meetings. Furthermore, design opportunities to address this issue in the context of online meetings remain underexplored.</p><p><strong>Objective: </strong>This study aims to investigate the design of effective antisedentary interactions for online meeting scenarios and understand user experiences with gamified bodily interactions as an antisedentary measure during online meetings.</p><p><strong>Methods: </strong>This study adopts a \"research through design\" approach to develop and explore user experiences of gamified bodily interactions as interventions to mitigate sedentary behavior during online meetings. In collaboration with 11 users, we co-designed and iterated 3 prototypes, which led to the development of the Bodily Interaction Gamification towards Anti-sedentary Online Meeting Environments (BIG-AOME) framework. Using these prototypes, we conducted user studies with 3 groups totaling 15 participants. During co-design and evaluation, all group semistructured interviews were transcribed into written format and analyzed using a conventional qualitative content analysis method.</p><p><strong>Results: </strong>The findings demonstrate that gamified bodily interactions encourage users to engage in physical movement while reducing the awkwardness of doing so during online meetings. Seamless integration with meeting software and the inclusion of long-term reward mechanisms can further contribute to sustained use. In addition, such games can serve as online icebreakers or playful tools for decision-making. Drawing from 3 design prototypes, this study offers a comprehensive analysis of each design dimension within the BIG-AOME framework: bodily engagement, attention, bodily interplay, timeliness, and virtual and physical environments.</p><p><strong>Conclusions: </strong>Our research findings indicate that antisedentary bodily interactions designed for online meetings have the potential to mitigate sedentary behaviors while enhancing social connections. Furthermore, the BIG-AOME framework that we propose explores the design space for antisedentary physical interactions in the context of online meetings, detailing pertinent design choices and considerations.</p>","PeriodicalId":14795,"journal":{"name":"JMIR Serious Games","volume":"13 ","pages":"e62778"},"PeriodicalIF":3.8,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12048789/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144004513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Smartwatch-Based Tailored Gamification and User Modeling for Motivating Physical Exercise: Experimental Study With the Maximum Difference Scaling Segmentation Method.","authors":"Jie Yao, Di Song, Tao Xiao, Jiali Zhao","doi":"10.2196/66793","DOIUrl":"10.2196/66793","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Smartwatch-based gamification holds great promise for enhancing fitness apps and promoting physical exercise; however, empirical evidence on its effectiveness remains inconclusive, partly due to \"one-size-fits-all\" design approaches that overlook individual differences. While the emerging research area of tailored gamification calls for more accurate user modeling and better customization of game elements, existing studies have relied primarily on rating scale-based measures and correlational analyses with methodological limitations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aimed to improve smartwatch-based gamification through an innovative user modeling approach to better motivate physical exercise among different user groups with tailored solutions. It incorporated both individual preferences and needs for game elements into the user segmentation process and used the maximum difference scaling (MaxDiff) technique, which can overcome the limitations of traditional methods.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;With data collected from 2 MaxDiff experiments involving 378 smartwatch users and latent class statistical models, the relative power of each of the 16 popular game elements was examined in terms of what users liked and what motivated them to exercise based on which distinct user segments were identified. Prediction models were also proposed for quickly classifying future users into the right segments to provide them with tailored gamification solutions on smartwatch fitness apps.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;We identified 3 segments of smartwatch users based on their preferences for gamification. More importantly, we uncovered 4 segments motivated by goals, immersive experiences, rewards, or social comparison. Such user heterogeneity confirmed the susceptibility of the effects of gamification and indicated the necessity of accurately matching gamified solutions with user characteristics to better change health behaviors through different mechanisms for different targets. Important differences were also observed between the 2 sets of user segments (ie, those based on preferences for game elements vs those based on the motivational effects of the elements), indicating the gap between what people enjoy using on smartwatches and what can motivate them for physical exercise engagement.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;To our knowledge, this study is the first to investigate MaxDiff-based user segmentation for tailored gamification on smartwatches promoting physical exercise and contributes to a detailed understanding of preferences for, and the effectiveness of, different game elements among different groups of smartwatch users. As existing tailored gamification studies continue to explore ways of user modeling with mostly surveys and questionnaires, this study supported the adoption of MaxDiff experiments as an alternative method to better capture user heterogeneity in the health domain and inform the desi","PeriodicalId":14795,"journal":{"name":"JMIR Serious Games","volume":" ","pages":"e66793"},"PeriodicalIF":3.8,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12048785/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143604914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Research Hotspots and Trends of Virtual Reality Intervention for Stroke: Bibliometric Analysis.","authors":"Yixin Wei, Yuan Chen, Runting Ma, Yitong Qiu, Wei Su, Li Zhang, Qiang Gao","doi":"10.2196/65993","DOIUrl":"https://doi.org/10.2196/65993","url":null,"abstract":"<p><strong>Background: </strong>Virtual reality (VR) is a rapidly developing technology that has gained significant traction in the treatment and rehabilitation of individuals with stroke. Research on VR-based stroke treatment has garnered increasing attention.</p><p><strong>Objective: </strong>The aim of this study is to present a bibliometric analysis of VR for stroke studies to identify the application status, research hotspots, and emerging trends and guide future scientific research.</p><p><strong>Methods: </strong>We included studies and reviews on the topic of VR-based stroke treatment and rehabilitation from 1999 to 2023 were retrieved from Web of Science Core Collection database. Citespace 6.3.1 and VOSviewer 1.6.20 software was used for the visual analysis of publications, institutions, authors, journals, citations, and Scimago Graphica software was used for the geographic visualization of published countries or regions.</p><p><strong>Results: </strong>Our study analyzed 1171 papers on VR-based stroke rehabilitation published between 1999 and 2023, revealing a gradual increase in annual publications over the past 2 decades, peaking at 154 in 2022. North America and Western Europe were identified as major contributors, with significant input from their institutions, researchers, and publications. The Journal of NeuroEngineering and Rehabilitation emerged as the leading journal in this field, while Calabrò Rocco Salvatore was recognized as the most prolific author, focusing on the neurophysiological impacts of VR on patients with stroke. Keywords with notable citation bursts, such as \"environment,\" \"trial,\" \"arm,\" and \"motor learning,\" highlighted the core research themes in this domain.</p><p><strong>Conclusions: </strong>Our study provides valuable insights into the current research hotspots and emerging trends in VR-based stroke treatment and rehabilitation. Current research primarily focuses on evaluating the effectiveness of VR in improving upper limb function and balance in patients with stroke. Future directions are shifting towards integrating VR with rehabilitation techniques, such as physiotherapy and occupational therapy, while advancements in VR technology continue to garner increasing attention.</p>","PeriodicalId":14795,"journal":{"name":"JMIR Serious Games","volume":"13 ","pages":"e65993"},"PeriodicalIF":3.8,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12016672/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143984844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Electrophysiological Insights in Exergaming-Electroencephalography Data Recording and Movement Artifact Detection: Systematic Review.","authors":"Carolina Rico-Olarte, Diego M Lopez, Bjoern M Eskofier, Linda Becker","doi":"10.2196/50992","DOIUrl":"10.2196/50992","url":null,"abstract":"<p><strong>Background: </strong>Exergames are interactive solutions that require physical activity and are commonly used in learning or rehabilitation settings. For cognitive rehabilitation with exergames, the assessment of the intervention progress can be conducted by verifying the changes in brain activity. Electroencephalography (EEG) is a well-known method for this evaluation. However, motion artifacts due to large body movements can impede signal quality. No comprehensive guide on the artifact removal methods in the context of exergaming has been found.</p><p><strong>Objective: </strong>This paper aimed to identify studies that have assessed EEG signals while a user interacts with an exergame and the applied methods for data handling and analysis with a focus on dealing with movement artifacts.</p><p><strong>Methods: </strong>This review included studies on human participants while engaging in exergames, where the primary outcome was brain activity measured by EEG. A total of 5 databases were searched at 3 time points: March 2021, October 2022, and February 2024. The Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies assessed methodological quality, rating studies as \"good,\" \"fair,\" or \"poor.\" Data were synthesized quantitatively to identify characteristics across studies, including sample demographics and intervention details, and basic statistics (mean [SD]) were calculated.</p><p><strong>Results: </strong>A total of 494 papers were screened, resulting in 17 studies having been included. All studies carried out EEG recordings during exergame interactions, primarily assessing attention and concentration, with the alpha wave being the most analyzed EEG band. Common motion artifact removal methods included visual inspection and independent component analysis. The review identified significant risks of bias, with 2 studies rated as \"good,\" 7 as \"fair,\" and 8 as \"poor.\" Due to the small number of studies and their heterogeneity, a meta-analysis was not feasible.</p><p><strong>Conclusions: </strong>The study successfully identifies the feasibility of recording electrophysiological brain activity during exergaming and provides insights into EEG devices, analysis methods, and exergaming systems used in previous studies. However, limitations, such as the lack of sufficient detail on motion artifact removal and a focus on short-term effects, underscore the need for improved methodologies and reporting standards, with recommendations for enhancing reliability in cognitive rehabilitation with exergames.</p>","PeriodicalId":14795,"journal":{"name":"JMIR Serious Games","volume":"13 ","pages":"e50992"},"PeriodicalIF":3.8,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12012405/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: Exergame (ExerG)-Based Physical-Cognitive Training for Rehabilitation in Adults With Motor and Balance Impairments: Usability Study.","authors":"Silvia Herren, Barbara Seebacher, Sarah Mildner, Yanick Riederer, Ulrike Pachmann, Nija Sonja Böckler, Stephan Niedecken, Sabrina Alicia Sgandurra, Leo Bonati, Isabella Hotz, Alexandra Schättin, Roman Jurt, Christian Brenneis, Katharina Lenfert, Frank Behrendt, Stefan Schmidlin, Lennart Nacke, Corina Schuster-Amft, Anna Lisa Martin-Niedecken","doi":"10.2196/73405","DOIUrl":"10.2196/73405","url":null,"abstract":"","PeriodicalId":14795,"journal":{"name":"JMIR Serious Games","volume":"13 ","pages":"e73405"},"PeriodicalIF":3.8,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11990637/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143784522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Digital Ergonomics of NavegApp, a Novel Serious Game for Spatial Cognition Assessment: Content Validity and Usability Study.","authors":"Juan Pablo Sanchez-Escudero, David Aguillon, Stella Valencia, Mauricio A Garcia-Barrera, Daniel Camilo Aguirre-Acevedo, Natalia Trujillo","doi":"10.2196/66167","DOIUrl":"10.2196/66167","url":null,"abstract":"<p><strong>Background: </strong>Alzheimer disease (AD) is the leading cause of dementia worldwide. With aging populations and limited access to effective treatments, there is an urgent need for innovative markers to support timely preventive interventions. Emerging evidence highlights spatial cognition (SC) as a valuable source of cognitive markers for AD. This study presents NavegApp, a serious game (SG) designed to assess 3 key components of SC, which show potential as cognitive markers for the early detection of AD.</p><p><strong>Objective: </strong>This study aimed to determine the content validity and usability perception of NavegApp across multiple groups of interest.</p><p><strong>Methods: </strong>A multistep process integrating methodologies from software engineering, psychometrics, and health measurement was implemented to validate the software. Our approach was structured into 3 stages, guided by the software life cycle for health and the Consensus-Based Standards for the Selection of Health Status Measurement Instruments (COSMIN) recommendations for evaluating the psychometric quality of health instruments. To assess content validity, a panel of 8 experts evaluated the relevance and representativeness of tasks included in the app. In addition, 212 participants, categorized into 5 groups based on their clinical status and risk level for AD, were recruited to evaluate the app's digital ergonomics and usability at various stages of development. Complementary analyses were performed to identify group differences and to explore the association between task difficulty and user agreeableness.</p><p><strong>Results: </strong>NavegApp was validated as a highly usable tool by both experts and users. The expert panel confirmed that the tasks included in the game were representative (Aiken V=0.96-1.00) and relevant (Aiken V=0.96-1.00) for measuring SC components. Both experts and nonexperts rated NavegApp's digital ergonomics positively, with minimal differences between groups (r_rb 0.08-0.29). Differences in usability perceptions were observed among participants with sporadic mild cognitive impairment compared to cognitively healthy individuals (r_rb 0.26-0.29). A moderate association was also identified between task difficulty and user agreeableness (Cramér V=0.37, 95% CI 0.28-0.54).</p><p><strong>Conclusions: </strong>NavegApp is a valid and user-friendly SG designed for SC assessment, developed by integrating software engineering and psychometric evaluation methodologies. While the results are promising, further studies are warranted to evaluate its diagnostic accuracy and construct validity. This work outlines a comprehensive framework for SG development in cognitive assessment, emphasizing the importance of incorporating psychometric validity measures from the outset of the design process.</p>","PeriodicalId":14795,"journal":{"name":"JMIR Serious Games","volume":"13 ","pages":"e66167"},"PeriodicalIF":3.8,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12004023/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Authors' Reply: Is the Pinball Machine a Blind Spot in Serious Games Research?","authors":"Luis Carlos Rodríguez Timaná, Javier Ferney Castillo García, Teodiano Bastos Filho, Alvaro Alexander Ocampo González, Nazly Rocio Hincapié Monsalve, Nicolas Jacobo Valencia Jimenez","doi":"10.2196/73034","DOIUrl":"10.2196/73034","url":null,"abstract":"","PeriodicalId":14795,"journal":{"name":"JMIR Serious Games","volume":"13 ","pages":"e73034"},"PeriodicalIF":3.8,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12038755/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is the Pinball Machine a Blind Spot in Serious Games Research?","authors":"Jens Peter Eckardt","doi":"10.2196/72354","DOIUrl":"10.2196/72354","url":null,"abstract":"","PeriodicalId":14795,"journal":{"name":"JMIR Serious Games","volume":"13 ","pages":"e72354"},"PeriodicalIF":4.1,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12304235/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physical Activity and Enjoyment in Active Virtual Reality Games in Youth: Comparative Analysis of Gorilla Tag and Beat Saber.","authors":"Brenden Boots, Daniel Berg, Easton Hewitt, Keith Naugle, Kelly Naugle","doi":"10.2196/66593","DOIUrl":"10.2196/66593","url":null,"abstract":"<p><strong>Background: </strong>Virtual reality (VR) active gaming is growing in popularity, but little is known about physical activity during gameplay. Two popular VR games are Gorilla Tag (Another Axiom Inc) and Beat Saber (Beat Games). Little is known about physical activity during these games in youth.</p><p><strong>Objective: </strong>The purpose of this study was to investigate the enjoyment, intensity, and amount of physical activity while playing Gorilla Tag and Beat Saber in early adolescent youth.</p><p><strong>Methods: </strong>Sixteen participants, 13 males and 3 females with an average age of 10.7 (SD 0.34) years, played 2 VR games (Gorilla Tag and Beat Saber) in a single session. Both games followed the same procedure: a maximum of 10-minute familiarization period, 5 minutes of rest, 15 minutes of gameplay, and 10 minutes of rest. Participants wore a heart rate monitor to track heart rate reserve (%HRR) and accelerometers on the wrist and waist to monitor time in sedentary activity, light physical activity, and moderate to vigorous physical activity of the arm and whole body. The Physical Activity Enjoyment Scale-Child Version (PACES) and ratings of perceived exertion (RPE) were completed after each game. Dependent t tests compared measures between games.</p><p><strong>Results: </strong>The results revealed that average and maximum %HRR were significantly higher during Gorilla Tag than during Beat Saber, with heart rate-based physical activity intensity reaching light for Beat Saber and moderate for Gorilla Tag. Arm moderate to vigorous physical activity and whole-body moderate to vigorous physical activity and light physical activity were greater during Gorilla Tag than during Beat Saber. Arm and whole-body sedentary time were significantly lower during Gorilla Tag than during Beat Saber. Gorilla Tag and Beat Saber were rated as highly enjoyable. There were no differences between games for maximum (P=.352) or average (P=.362) RPE. Both games were rated as light intensity for average RPE (Gorilla Tag: mean 4.3, SD 1.9; Beat Saber: mean 4.7, SD 2.3) and moderate intensity for maximum RPE (Gorilla Tag: mean 5.4, SD 1.9; Beat Saber: mean 5.8, SD 2.4).</p><p><strong>Conclusions: </strong>These results suggest that Beat Saber produced light-intensity physical activity and Gorilla Tag produced light- to moderate-intensity physical activity in early adolescent youth, with both games rated as highly enjoyable.</p>","PeriodicalId":14795,"journal":{"name":"JMIR Serious Games","volume":"13 ","pages":"e66593"},"PeriodicalIF":3.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11978236/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Considering Theory-Based Gamification in the Co-Design and Development of a Virtual Reality Cognitive Remediation Intervention for Depression (bWell-D): Mixed Methods Study.","authors":"Mark Hewko, Vincent Gagnon Shaigetz, Michael S Smith, Elicia Kohlenberg, Pooria Ahmadi, Maria Elena Hernandez Hernandez, Catherine Proulx, Anne Cabral, Melanie Segado, Trisha Chakrabarty, Nusrat Choudhury","doi":"10.2196/59514","DOIUrl":"10.2196/59514","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;In collaboration with clinical domain experts, we developed a prototype of immersive virtual reality (VR) cognitive remediation for major depressive disorder (bWell-D). In the development of a new digital intervention, there is a need to determine the effective components and clinical relevance using systematic methodologies. From an implementation perspective, the effectiveness of digital intervention delivery is challenged by low uptake and high noncompliance rates. Gamification may play a role in addressing this as it can boost adherence. However, careful consideration is required in its application to promote user motivation intrinsically.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;We aimed to address these challenges through an iterative process for development that involves co-design for developing content as well as in the application of gamification while also taking into consideration behavior change theories. This effort followed the methodological framework guidelines outlined by an international working group for development of VR therapies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;In previously reported work, we collected qualitative data from patients and care providers to understand end-user perceptions on the use of VR technologies for cognitive remediation, reveal insights on the drivers for behavior change, and obtain suggestions for changes specific to the VR program. In this study, we translated these findings into concrete representative software functionalities or features and evaluated them against behavioral theories to characterize gamification elements in terms of factors that drive behavior change and intrinsic engagement, which is of particular importance in the context of cognitive remediation. The implemented changes were formally evaluated through user trials.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The results indicated that feedback from end users centered on using gamification to add artificial challenges, personalization and customization options, and artificial assistance while focusing on capability as the behavior change driver. It was also found that, in terms of promoting intrinsic engagement, the need to meet competence was most frequently raised. In user trials, bWell-D was well tolerated, and preliminary results suggested an increase in user experience ratings with high engagement reported throughout a 4-week training program.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In this paper, we present a process for the application of gamification that includes characterizing what was applied in a standardized way and identifying the underlying mechanisms that are targeted. Typical gamification elements such as points and scoring and rewards and prizes target motivation in an extrinsic fashion. In this work, it was found that modifications suggested by end users resulted in the inclusion of gamification elements less commonly observed and that tend to focus more on individual ability. It was found that the incorp","PeriodicalId":14795,"journal":{"name":"JMIR Serious Games","volume":"13 ","pages":"e59514"},"PeriodicalIF":3.8,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11997539/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}