JMIR Serious Games最新文献

{"title":"Effects of Virtual Nature Embodiment on Compassion, Empathy, Nature Connectedness, and Symptom Burden in Patients With Psychosis or Depression: An Explorative Clinical Study.","authors":"Alva Lütt, Kristina Lütgens, Christiane Montag, Stefan Gutwinski, Georg Felix Reuth, Steve Nebel, Felix Bermpohl, Pia Spangenberger","doi":"10.2196/74337","DOIUrl":"10.2196/74337","url":null,"abstract":"<p><strong>Background: </strong>Nature experiences may have a positive impact on mental health. Innovative alternatives, such as immersive virtual reality (iVR), can have similar effects. In previous studies on embodying a tree in virtual reality, connectedness to nature has been induced in healthy participants and shown to be influenced by compassion. Compassion and empathy, however, can be altered in psychiatric disorders, leading to impaired relationships with fellow human beings. The potential effect of nature experiences in iVR on compassion, empathy, and nature connectedness in mental health disorders has not yet been investigated.</p><p><strong>Objective: </strong>This study aims to examine the development of nature connectedness, compassion, empathy, and individual symptom load in patients with depression (n=20), schizophrenia (n=20), and healthy controls (n=20), measured pre and post 1 session of virtual embodying a rainforest tree.</p><p><strong>Methods: </strong>We conducted an explorative clinical trial, comparing 3 groups (depression, schizophrenia, and healthy control), using repeated measures ANOVA and multiple regression analysis. Effect sizes (η<sub>p</sub><sup>2</sup>) and 95% CIs were reported where applicable. We assessed the impact of iVR-exposure on nature connectedness, empathy, compassion, individual symptoms, spirituality, cybersickness, presence, and virtual body ownership. Electrodermal activity was measured to capture physiological correlates of emotional arousal.</p><p><strong>Results: </strong>Individual symptom load decreased significantly through the experience of embodying a growing tree in iVR in both patient groups (F<sub>1,38</sub>=40.93, η<sub>p</sub><sup>2</sup>=0.52, 95% CI 0.29-0.67; P<.001). All groups benefited equally from the iVR experience regarding a change in nature connectedness (F<sub>1,57</sub>=100.12, η<sub>p</sub><sup>2</sup>=0.637, 95% CI 0.48-0.74; P<.001) and compassion (F<sub>1,57</sub>=12.86, η<sub>p</sub><sup>2</sup>=0.18, 95% CI 0.04-0.36; P<.001). The change in empathy did not differ significantly between the 3 groups. The analysis of electrodermal activity during iVR showed significantly higher nonspecific skin conductance response numbers than at the beginning of the iVR (2-tailed t<sub>53</sub>=4.40, mean difference=2.38, 95% CI 1.30-3.46; P<.001). Changes in compassion were predicted by spirituality (β=-0.35, 2-tailed t<sub>59</sub>=-2.89, η<sub>p</sub><sup>2</sup>=0.13, 95% CI 0.01-0.30; P=.005) and virtual body ownership (β=0.29, 2-tailed t<sub>59</sub>=2.15, η<sub>p</sub><sup>2</sup>=0.08, 95% CI 0.00-0.23; P=.04) but not by the feeling of presence.</p><p><strong>Conclusions: </strong>Our results indicate that virtually embodying a tree seems to have a positive effect on individual symptoms. Patients with depression and schizophrenia were able to receive an iVR-based intervention and benefited from the experience. Our results provide a deeper understanding of the phenomenon of vir","PeriodicalId":14795,"journal":{"name":"JMIR Serious Games","volume":"14 ","pages":"e74337"},"PeriodicalIF":4.7,"publicationDate":"2026-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13058528/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147503888","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":"The Effects of Dance-Based Exergaming on Mental Rotation, General Motor Coordination, and Math Achievement in Adolescent Students: Nonrandomized Controlled Pilot Study.","authors":"Patrick Fargier, Valérian Cece, Vanessa Lentillon-Kaestner, Cédric Roure","doi":"10.2196/82610","DOIUrl":"10.2196/82610","url":null,"abstract":"<p><strong>Background: </strong>Exergaming can promote adolescent health by encouraging repetition of game-related tasks, potentially contributing to academic success by developing motor and cognitive skills. Studies have highlighted the influence of exergaming on motor skill learning but have not clarified its effects on general motor coordination. Other studies suggest that exergames may influence math success, particularly with nonmathematical, dance-based exergames, possibly through mental rotation or general motor coordination training. However, the influence of a single exergaming sequence on these abilities and on math achievement in the same participants has not been studied.</p><p><strong>Objective: </strong>This study aimed to determine whether nonmathematical dance-based exergaming (DEx) improves mental rotation, general motor coordination, and math achievement in adolescent students.</p><p><strong>Methods: </strong>An experimental group (EG: 15 girls and 15 boys; mean age 14.0, SD 0.7 years) and a control group (CG: 14 boys and 12 girls; mean age 14.2, SD 0.9 years), with no contraindications to physical activity or special educational needs, participated in this nonrandomized controlled study. EG performed DEx involving varied locomotion and interlimb coordination, while CG performed precision ball-throwing exergaming (TEx), requiring catching and throwing. Only DEx involved mental rotation; neither of the two involved mathematical content. Both consisted of 5 weekly 45-minute sessions, implemented using the Lü platform. A pretest-posttest design compared effects on (1) a mental rotation test, (2) locomotion and sprint tests, and (3) quantity comparison plus simple and complex addition and multiplication tests. Each session led to noninstrumented observation, and sessions 3 and 5 included instrumented tracking of physical activity and situational interest.</p><p><strong>Results: </strong>Monitoring of the sequences highlighted a significant between-group difference in triggered situational interest in session 5 (multivariate analysis of variance: F<sub>1,54</sub>=9.15; P=.004; η<sub>p</sub><sup>2</sup>=0.14). This variable was added as a covariate in the analyses of covariance (ANCOVAs), with generalized linear model approach performed further. ANCOVA results showed an advantage for EG over CG in terms of mental rotation (F<sub>1,52</sub>=6.17; P=.02; η<sub>p</sub><sup>2</sup>=0.11), number of correct simple additions (F<sub>1,52</sub>=8.26; P=.006; η<sub>p</sub><sup>2</sup>=0.14), and error rate in complex addition (F<sub>1,52</sub>=8.40; P=.005; η<sub>p</sub><sup>2</sup>=0.14). No other significant results were found.</p><p><strong>Conclusions: </strong>This study helps clarify the previously unexplored influence of the same exergaming sequence on mental rotation and math skills by showing the positive influence of DEx on mental rotation and only on calculations involving mental rotation, according to the literature. Further resear","PeriodicalId":14795,"journal":{"name":"JMIR Serious Games","volume":"14 ","pages":"e82610"},"PeriodicalIF":4.7,"publicationDate":"2026-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13047359/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147486082","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":"Game Elements in Military Trauma Care Education: Systematic Review.","authors":"Natalia Stathakarou, Andrzej A Kononowicz, Maxine G Harjani, Cara Swain, Klas Karlgren","doi":"10.2196/79163","DOIUrl":"10.2196/79163","url":null,"abstract":"<p><strong>Background: </strong>Game elements may inform the design of both simulations and games. However, evidence on how individual game elements inform the design of military trauma training simulations and their educational purpose remains limited.</p><p><strong>Objective: </strong>This systematic review aimed to examine which game elements are used in the design of educational simulations for military trauma management, how they are implemented, for what purpose, and what outcomes are reported related to the game elements.</p><p><strong>Methods: </strong>This is a systematic review conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We included qualitative, quantitative, mixed methods, and design studies describing simulation-based training for military trauma management that incorporated game elements. Studies focusing solely on assessment, noninteractive interventions, or psychological trauma were excluded. Searches were conducted in Medline (Ovid), PubMed, IEEE Xplore, ERIC, Web of Science, ACM Digital Library, and CINAHL from inception to October 14, 2025, identifying 2487 records. Screening and data extraction were performed independently by 2 reviewers. Methodological quality was assessed using the Medical Education Research Study Quality Instrument (MERSQI) and the Côté and Turgeon grid. Results were synthesized using qualitative thematic synthesis.</p><p><strong>Results: </strong>Forty-two studies published between 1986 and 2025 were included. Most studies were conducted in the United States and included a wide range of simulation modalities and learner populations. Sixteen game elements were identified, with narrative, sensation, imposed choice, time pressure, and scoring being most prevalent. The thematic synthesis identified multiple categories describing how these game elements were implemented. Justifications for the use of game elements were rarely provided; when present, they were primarily linked to realism, emotional engagement, adaptive learning, and feedback. Elements such as badges and competition were seldom used. No study explicitly linked individual game elements to specific educational outcomes. This review is constrained by heterogeneity across studies, an imperfect fit of quality appraisal tools for some study types, and the possibility of missed studies due to search vocabulary limitations.</p><p><strong>Conclusions: </strong>This systematic review is innovative in providing the first comprehensive synthesis of how game elements are used in military trauma simulations. Unlike previous reviews, it explicitly focuses on the pedagogical purposes of these elements. It offers an overview of the prevalence of game elements in military trauma care education and synthesizes the pedagogical rationales for their use. The lack of studies explicitly linking individual game elements to learning outcomes highlights the need for more intentional research and transp","PeriodicalId":14795,"journal":{"name":"JMIR Serious Games","volume":"14 ","pages":"e79163"},"PeriodicalIF":4.7,"publicationDate":"2026-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13040169/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147473767","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":"Development of a Novel Dietary Assessment Method Using Gamification Concepts: Exploratory and Application Study.","authors":"Yulin Zhang, Tianwu Lin, Yuefeng Tan, Xiaojin Shi, Yucheng Yang, Haibing Yang, Xiaona Na, Junhan Zhang, Ai Zhao","doi":"10.2196/72387","DOIUrl":"10.2196/72387","url":null,"abstract":"<p><strong>Background: </strong>Childhood and adolescent malnutrition, encompassing undernutrition and overnutrition, poses significant global health challenges, necessitating comprehensive dietary assessment tools. Existing dietary assessment methods, such as 24-hour dietary recalls (24HR), often fail to capture eating behaviors and food preferences.</p><p><strong>Objective: </strong>This study aims to compare a newly developed gamified dietary assessment tool (GDA) with a traditional 24HR and to explore its applicability in assessing dietary behavior tendencies among children and adolescents.</p><p><strong>Methods: </strong>A 2-phase study was designed, including an exploratory and an application study. The exploratory study included 30 school-aged participants, comparing the GDA with the 3-day 24HR. Nutrient and food intakes were analyzed using Pearson or Spearman correlation coefficients and Bland-Altman plots. The application study, conducted among 1541 adolescents (11-18 y), assessed dietary intake and eating behavior tendencies. Differences in dietary intake across age, gender, socioeconomic status, and weight status were analyzed using the Kruskal-Wallis rank sum test. Multiple linear regression models were used to examine the associations of dietary intakes with emotional eating and with dining environment tendencies, respectively.</p><p><strong>Results: </strong>In the exploratory study (n=30), the GDA demonstrated moderate agreement with 24HR for energy (r=0.46, P=.01) and carbohydrates (r=0.50, P=.005). Bland-Altman plots indicated good agreement for energy and carbohydrate intake between methods (mean differences around 0). For fat intake, although the mean difference was close to 0, the correlation was not statistically significant. In contrast, the GDA substantially overestimated protein intake (mean difference around 25 g). In the application study (n=1541), higher emotional eating scores were associated with higher snack consumption (β=0.438, 95% CI 0.035-0.840), and with lower protein (β=-0.159, 95% CI -0.267 to -0.052), fruit (β=-0.464, 95% CI -0.854 to -0.073), and nut consumption (β=-0.183, 95% CI -0.304 to -0.062). Participants who chose solitary screen eating consumed significantly more carbohydrates than those who selected \"eat with peers\" (β=4.2, 95% CI 1.2-7.1).</p><p><strong>Conclusions: </strong>This study demonstrates that the GDA effectively captures both dietary intake and contextual eating behaviors in young populations, providing data distinct from traditional methods, such as 24HR. As a complementary assessment approach, it offers valuable insights into food preferences and eating patterns through its interactive design.</p>","PeriodicalId":14795,"journal":{"name":"JMIR Serious Games","volume":"14 ","pages":"e72387"},"PeriodicalIF":4.7,"publicationDate":"2026-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12987409/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147457327","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: Children's Improvement After Language and Rhythm Training With the Digital Medical Device Poppins for Dyslexia: Single-Arm Intervention Study.","authors":"Charline Grossard, Melanie Descamps, Hugues Pellerin, François Vonthron, David Cohen","doi":"10.2196/93737","DOIUrl":"10.2196/93737","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.2196/76435.].</p>","PeriodicalId":14795,"journal":{"name":"JMIR Serious Games","volume":"14 ","pages":"e93737"},"PeriodicalIF":4.7,"publicationDate":"2026-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13022534/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147443601","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":"Feasibility and User Experience of Immersive Virtual Reality-Based Rehabilitation in Patients With Stroke: Single-Arm Pretest-Posttest Pilot Study.","authors":"Sara Arlati, Marta Mondellini, Isabella Martinelli, Eleonora Guanziroli, Mauro Rossini, Marco Sacco, Franco Molteni","doi":"10.2196/79584","DOIUrl":"10.2196/79584","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Immersive virtual reality (VR) is promising in stroke rehabilitation; it is believed to promote motivation and intervention adherence among patients. However, existing work often lacks a structured assessment of user experience over a longer period of time.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aimed to assess the feasibility, user experience, and preliminary effectiveness of a VR-based rehabilitation program designed for patients with stroke to train upper limb and cognitive functions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Thirty-two chronic (n=19, 59%) or postacute (n=13, 41%) patients with stroke (mean age 60, SD 11 years) were enrolled. All participants performed 4 weeks of training, performing exercises in the Virtual Supermarket for Stroke (VSS). The VSS is an ecological VR-based application allowing customization of difficulty to make the task of \"doing the shopping\" more challenging throughout the sessions. Subjective outcomes were assessed after the first and last sessions. Clinical scales were administered at baseline and at the end of the treatment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 32 participants, 31 (97%) completed the training. Flow (median 4.56, IQR 3.94-4.72; 5-point scale), sense of presence (Spatial Presence: median 3.44, IQR 12.85-3.85; Engagement: median 3.79, IQR 3.26-4.191; Naturalness: median 3.60, IQR 3.20-4.40; all 5-point scales), and affective state-related variables (Positive and Negative Affect Schedule; Positive Affect: median 4.60, IQR 4.00-5.00; Negative Affect: median 1, IQR 1.00-1.00) were satisfactory after the first session. Perceived ease of use was rated as very high (median 6.75, IQR 6.00-7.00; 7-point scale). No severe symptoms of cybersickness were recorded (Simulator Sickness Questionnaire [SSQ-TS]: median 11.22, IQR 0-20.57). At the end of the intervention, no significant differences were recorded in any subjective variable. Regarding clinical outcomes, significant improvements were recorded in balance (Berg Balance Scale pre: median 30, IQR 14.00-45.75; post: median 33.5, IQR 17.00-47.00; P=.02), upper limb motor functions (Motricity Index pre: median 45, IQR 15.25-69.00; post: median 46, IQR 32.00-77.00; P=.02; Box and Block pre: median 0, IQR 0-11.5; post: median 0, IQR 0-28; P=.005), and functional mobility (Time Up and Go pre: median 18, IQR 13.25-34.50; post: median 14, IQR 9.00-26.00; P=.005). No significant differences were recorded for general cognitive abilities (Mini-Mental State Examination pre: median 27, IQR 25-28; post: median 28, IQR 26-29), spasticity, and pain (visual analog scale pre: median 0, IQR 0-3.5; post: median 0, IQR 0-2).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The study showed the preliminary feasibility of a rehabilitation program using the VSS. It addressed the essential topic of assessing VR-based rehabilitation user experience throughout the entire training period, shedding light on the features that can contribute to an optimal psychologica","PeriodicalId":14795,"journal":{"name":"JMIR Serious Games","volume":"14 ","pages":"e79584"},"PeriodicalIF":4.7,"publicationDate":"2026-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12978540/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147432947","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":"Home-Based Immersive Virtual Reality to Improve Motor Performance in Children and Adolescents With Developmental Coordination Disorder: Crossover Study.","authors":"Mohammed Alharbi, David Harris, Helen Dodd, Greg Wood, Gavin Buckingham","doi":"10.2196/84995","DOIUrl":"10.2196/84995","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Children with developmental coordination disorder (DCD) experience motor difficulties that limit daily activities and reduce physical activity enjoyment. Immersive virtual reality (VR) offers the potential for feedback-rich movement practice, but evidence for these effects in DCD remains limited.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aims to investigate the effects of an immersive VR rhythm game compared to tablet-based gameplay within a home-based setting on motor performance, enjoyment, and motivation in children and adolescents with DCD.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This crossover study included 27 participants (21 boys and 6 girls) aged 10 to 16 years with DCD who completed 2 home-based interventions, each delivered over 5 consecutive days: VR gameplay using Beat Saber (Beat Games) and tablet-based gameplay using Cut the Rope (ZeptoLab). Participants were recruited in England using convenience sampling via social media; eligible participants were aged 10 to 16 years, met research criteria for DCD based on a Developmental Coordination Disorder Questionnaire screening, and had no alternative neurological or musculoskeletal diagnosis. Each condition required at least 30 minutes of daily gameplay and was separated by a 2-week or more washout period. Motor performance was assessed pre- and postintervention using the Movement Assessment Battery for Children, Third Edition (MABC-3) and the Box and Block Test. Enjoyment was measured pre- and postintervention using the Physical Activity Enjoyment Scale. Participants also rated their motivation and feelings during each gameplay session. Repeated-measures ANOVAs and paired-samples 2-tailed t tests (α=.05) were used to examine the data.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;For MABC-3 domains, condition × time interactions were nonsignificant, although exploratory within-condition analyses showed pre-post improvements in the VR condition. For the Box and Block Test, condition × time interactions were significant for both hands, with a greater degree of pre-post improvement in VR than tablet-based gameplay. In the VR condition, mean block transfer increased for the dominant hand (ΔM 5.93, 95% CI 3.49-8.36; t26=-4.99; P&lt;.001; Cohen d=0.96) and the nondominant hand (ΔM 5.11, 95% CI 2.65-7.57; t26=-4.27; P&lt;.001; Cohen d=0.82), whereas no significant changes were observed in the tablet condition (all P≥.36). VR gameplay also yielded higher enjoyment, and children reported higher motivation and feeling ratings across VR sessions than tablet sessions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This study, in contrast to most of the existing literature on nonimmersive technologies, examined the effect of a home-based immersive VR rhythm game intervention for children and adolescents with DCD. This study provides early evidence that this VR rhythm game was engaging and may support greater short-term improvements in motor performance than tablet gameplay. These findings suggest home-ba","PeriodicalId":14795,"journal":{"name":"JMIR Serious Games","volume":"14 ","pages":"e84995"},"PeriodicalIF":4.7,"publicationDate":"2026-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12990058/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147467107","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":"The Mechanism and Design Principles of Serious Games in Enhancing Adolescents' Internet Adaptability.","authors":"Shijie Gao, Min Jia, Weijun Wang, Jianping Hu, Shihao Ma","doi":"10.2196/82505","DOIUrl":"10.2196/82505","url":null,"abstract":"<p><strong>Unlabelled: </strong>Adolescents' internet adaptability (IA) is crucial for their online behavior and mental health. Serious games (SGs), as an emerging educational tool, hold promise for enhancing this adaptability through engaging, goal-oriented learning. Yet, direct evidence in this area remains limited. This viewpoint aims to clarify the mechanisms through which SGs enhance adolescents' IA and to derive corresponding design principles that can inform educational practice and game development. Drawing on insights from both Chinese and international studies, this study adopts a cross-contextual perspective to explore how SGs can foster IA in varied educational environments. Beyond synthesizing existing findings, this viewpoint provides an integrated account of why IA is essential in contemporary digital life and how SGs can support its development. It proposes a 3-stage framework, illustrating how contextualized design, real-time feedback, and dynamic tasks promote experiential learning, self-regulation, and the transfer of online skills. Based on this framework, the study further articulates 6 core design principles: clear goal definition, interaction diversity, contextual authenticity, immediate, scaffolding and explanatory feedback, a dynamically adaptive learning environment, and safety-by-design for digital well-being. These principles translate the core characteristics and mechanisms of SGs into actionable guidance for developing effective IA interventions. By synthesizing theoretical insights with practical considerations, this viewpoint highlights how SGs can serve as accessible and scalable tools to support adolescents in navigating increasingly complex digital environments. Together, these insights provide practical implications for educators, curriculum designers, and digital game developers seeking to foster adolescents' safe, responsible, and adaptive engagement in online environments.</p>","PeriodicalId":14795,"journal":{"name":"JMIR Serious Games","volume":"14 ","pages":"e82505"},"PeriodicalIF":4.7,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12978936/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147433020","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":"Longitudinal Association Between Internet Gaming Disorder and School Refusal Among Adolescents Using a Random Intercept Cross-Lagged Panel Model: Three-Wave Prospective Cohort Study.","authors":"Peng Zheng, Zi Tao, Luoxiang Fang, Tao Yao, Lingling Zhou, Yutian Wang, Yuannan Lin","doi":"10.2196/89619","DOIUrl":"10.2196/89619","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Internet gaming disorder (IGD) and school refusal are increasingly prevalent during adolescence, yet limited research has examined how they influence each other over time. Moreover, it is unclear whether the association differs by sex.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aimed to investigate the within-person longitudinal associations between school refusal and IGD and potential sex differences in these associations among Chinese adolescent gamers.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A 3-wave prospective cohort longitudinal study was conducted among students from 4 middle schools in Zhejiang Province, China. Adolescents who had played online games in the past 12 months were involved. Participants were recruited using convenience sampling. Data were collected at 6-month intervals: time 1 (T1, March 2024), time 2 (T2, September 2024), and time 3 (T3, March 2025). A total of 918 Chinese adolescents (n=609, 66.3% male; mean 13.55, SD 0.75) participated in the 3-wave survey. IGD and school refusal were assessed using the 9-item DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) IGD checklist and the School Refusal Assessment Scale-Revised. A random intercept cross-lagged panel model and multigroup analyses were conducted.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;All statistical tests were 2-tailed with α=.05. The random intercept cross-lagged panel model demonstrated good fit to the data (χ²5=16.02; comparative fit index 0.970; root mean square error of approximation 0.035). Cross-lagged effects indicated a reciprocal association between school refusal and IGD. School refusal predicted later IGD (T1→T2: β=.06, 95% CI .02-.08; P=.02 and T2→T3: β=.06, 95% CI .02-.08; P=.02), and IGD predicted subsequent school refusal (T1→T2: β=.12, 95% CI .09-.15; P&lt;.001 and T2→T3: β=.13, 95% CI .08-.16; P&lt;.001). Multigroup analyses revealed significant sex differences. Wald tests showed sex-specific effects: among females, school refusal predicted later IGD (T1→T2: β=.10, 95% CI .05-.15; P=.006 and T2→T3: β=.11, 95% CI .04-.17; P=.004), whereas these paths were nonsignificant for males. IGD predicted later school refusal in both sexes, but the effect was stronger for males (T1→T2: β=.15, 95% CI .12-.18; P&lt;.001 and T2→T3: β=.15, 95% CI .12-.18; P&lt;.001) than females (T1→T2: β=.07, 95% CI .03-.10; P=.02 and T2→T3: β=.07, 95% CI .03-.10; P=.02).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This study provides novel insights into the reciprocal within-person associations between school refusal and IGD among adolescents. By accounting for stable between-person differences, the model clarifies how within-person fluctuations in one behavior relate to subsequent changes in the other. Sex-specific patterns were observed: school refusal predicted subsequent IGD among females, whereas IGD predicted later school refusal more strongly among males. These findings highlight the dynamic interplay between school disengagement and problematic","PeriodicalId":14795,"journal":{"name":"JMIR Serious Games","volume":"14 ","pages":"e89619"},"PeriodicalIF":4.7,"publicationDate":"2026-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12979252/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147432970","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":"Design and Iterative Development of Serious Exergames for Children With Autism Spectrum Disorder: Formative Multiple-Case Pilot Study.","authors":"Won Kim, Minwoo Seong, SeungJun Kim","doi":"10.2196/77727","DOIUrl":"10.2196/77727","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Children with autism spectrum disorder (ASD) exhibit cognitive, motor, and social difficulties that affect engagement, causing developmental delays, behavioral challenges, and obesity-interrelated concerns in daily functioning and well-being. Although interactive interventions have incorporated physical activity, they often rely on limited physical involvement and lack iterative, expert-informed design, as built on pre-existing game frameworks. Physical activity is often operationalized as constrained input (eg, gestures or in-place actions) rather than exertion-intensive, whole-body exercise, and design guidance for adapting exercise content under ASD-oriented safety and cognitive-sensory constraints remains limited. These limitations highlight the need for exergames that promote sustained, full-body participation aligned with developmental goals, motivating formative, co-design with expertise and initial field testing in this population.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;We aim to iteratively design exercise-based serious games (SGs) for children with ASD through a structured, expert-informed co-design process involving 21 professionals across special education, adapted physical education, and human-computer interaction, and to examine feasibility and use contexts through an exploratory multiple-case pilot study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We derived serious exergames using 4 design methods-stakeholder interview, concept mapping, creative matrix, and visualize the vote. Two exergames-\"Fruit Sorting Run\" and \"Hazard Avoiding Ride\"-were developed, integrating full-body running and cycling movements into goal-directed tasks under ASD-oriented constraints. We conducted a multiple-case pilot with 3 children with ASD. During gameplay, caregivers labeled engagement using a binary input interface, and we conducted postsession caregiver interviews to capture complementary observations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Engagement in both exergames tended to increase over normalized time. Generalized estimating equations with a logit link and an autoregressive working correlation of order 1 (AR1), including participant indicators, showed a statistically significant association between normalized time and engagement in Fruit Sorting Run (per 0.1 increase: β=0.48; odds ratio 1.62, 95% CI 1.09-2.38; P=.02) and Hazard Avoiding Ride (per 0.1 increase: β=0.66; odds ratio 1.93, 95% CI 1.04-3.60, P=.04). Caregiver interviews reinforced these findings, reporting increased attention, motivation, and enjoyment across both activities.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The findings support the applicability of an expert-informed design approach and the viability of the resulting exergames, integrating goal-directed physical activity, virtual agent-based prompting, and stakeholder-informed considerations such as motor-cognitive alignment, interactive scaffolding, and support for daily living skills. Distinct from prior SG approache","PeriodicalId":14795,"journal":{"name":"JMIR Serious Games","volume":"14 ","pages":"e77727"},"PeriodicalIF":4.7,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12993268/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147325910","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}