# Book of Abstracts – SeGAH 2025

13th International Conference on Serious Games and Applications for Health
6–8 August 2025 · Manchester Metropolitan University · United Kingdom

##

##

## Editors

Nuno Dias, 2Ai – Applied Artificial Intelligence Laboratory – IPCA, Portugal
John Henry, Manchester Metropolitan University, United Kingdom
Nuno Rodrigues, 2Ai – Applied Artificial Intelligence Laboratory – IPCA, Portugal
Eva Oliveira, 2Ai – Applied Artificial Intelligence Laboratory – IPCA, Portugal
Duarte Duque, 2Ai – Applied Artificial Intelligence Laboratory – IPCA, Portugal
Misbahu Zubair, Manchester Metropolitan University, United Kingdom
João L. Vilaça, 2Ai – Applied Artificial Intelligence Laboratory – IPCA, Portugal

##

##

## Sponsors

##

##

## Oral Presentations

233 – Machine Learning Prediction of Pokemon Go Exergame Enjoyment

Cameron Maitland and Emmanuel Agu

[Download Paper]

Keywords: exergame, machine learning, enjoyment prediction

Abstract:

Physical inactivity is on the rise, with dire consequences such as obesity and many diseases. Exergames, which try to gamify physical activity, have been demonstrated to be an effective solution. For exergames to be effectively improve health, they have to be played for extended periods of time. However, prior work has found that while many players enjoy exergames initially, they often suddenly stop playing. For instance, nearly 85% of exergame players quit after a day, and 95% within 3 months. We believe that if timepoints at which a player stops enjoying an exergame can be predicted from objective data, mitigating action such as recommending a new exergame, can be taken to sustain the user engagement. In this paper, we explored whether player enjoyment of Pokemon Go can be predicted using machine learning analyses on location, step count, game usage and session statistics and weather data. We found that Bagged trees performed best overall, predicting player Exergame Enjoyment Questionnaire (EEQ) scores with a 74% accuracy.

792 – A Suite of Games to Estimate the Severity of Nystagmus

Joerg Fliege, Venezia Georgieva, Jay Self, James Stallwood, Vanissa Wanick and Adam Watts

[Download Paper]

Keywords: nystagmus, health assessment, serious games

Abstract:

Nystagmus is a condition of rapid, uncontrollable eye movement. It affects ca. 24 out of 10,000 people in the general population. Measuring the impact of nystagmus on visual acuity remains challenging, as patients often perform well on standard tests like Snellen charts. For this reason we have created a suite of games, BRIGHTSIGHT BURGERS, with simple mechanics mea- suring specific player performance metrics related to nystagmus. Our preliminary result indicate the potential effectiveness of games as tools for health assessment in this context. We provide a detailed description of the games developed, the incorporation of player performance metrics for assessment of the severity of the nystagmus condition, and describe results of a preliminary analysis and insights gained. These preliminary results indicate that healthy subjects take significant less time to finish any of the assigned tasks in any of the

930 – Empowering Novice Designers to Design and Prototype Tailored Assistive Technologies for Children with Autism

Raquel Cañete, Keith E. Green and Estela Peralta

[Download Paper]

Keywords: Autism Spectrum Disorder, Assistive technology, Rapid prototyping, Design Engineering Pedagogy.

Abstract:

Autism is a wide spectrum, with each child presenting unique needs. Many assistive technologies for autism are excessively expensive, lack tangibility, or are not adapted to specific preferences. Those best positioned to design for these needs are individuals closest to them: family members, therapists, and teachers. With new means of rapid prototyping (user-friendly electronics, digital fabrication, and AI tools) and a 4-step method of our own, 15 novice designers from universities in the USA and Spain created assistive technology prototypes tailored to specific profiles. These prototypes were evaluated by 14 participants (families, teachers, therapists, and designers) via an online survey. Findings suggest rapid prototyping enables inexperienced designers to develop functional products that improve the well-being of children with autism. This work explores structured guidance for designing for autism, enabling even novice designers to effectively develop assistive technologies with proper mentorship.

1071 – Gamified E-Quizzes with Accountable Academic Role-Play in An Interactive Narrative Scenario

Dongjie Xu and Ioannis Doumanis

[Download Paper]

Keywords: gamified e-quizzes, accountable academic role-play, digital game-based learning (DGBL)

Abstract:

While previous research on gamified e-quizzes is not scarce, the impact of accountable academic role-play in gamified e-quizzes remains underexplored. Most role-play in gamified e-quizzes is designed to shift students’ attention from mundane tasks to engaging adventures or immersive storylines. In practice, however, students, regardless of age, are often motivated by exams and assignment deadlines. Therefore, it may not be necessary to distract them from their academic roles to enhance performance. For example, the teacher-in-role method has been shown to effectively engage young learners and improve learning outcomes. A strong sense of responsibility could serve as a key driving force for improved learning outcomes and engagement. This study investigated whether pupils’ learning performance and engagement could be enhanced through a gamified e-quiz incorporating accountable academic role-play within an interactive narrative, compared to traditional e-quiz usage. Two academic roles, student and teacher, were selected, as they are the most familiar to pupils. In one experimental group, participants’ sense of being a student was reinforced by providing a non-player character (NPC) mentor to guide them through the process of answering the e-quiz. In the other group, they assumed the role of a teacher, assisting an NPC student in answering the same questions. The role-plays were embedded within an exam preparation scenario to immerse pupils in an academic environment and heighten their sense of responsibility. A quasi-experimental approach was implemented, as participants were drawn from three schools and were not randomly assigned. The study found no significant improvements in learning performance or engagement in the experimental groups. After comparing its setup with that of previous research, possible reasons and suggestions were discussed. Future research will aim to deepen the academic role-play experience and create a more immersive virtual academic environment, thereby reinforcing pupils’ sense of responsibility to perform better.

1328 – Persuasion and Behavior Change in ChatGPT-Based Dietary Management

Grace Ataguba, Oladapo Oyebode, Fidelia Orji, Kosi Clinton Henry and Rita Orji

[Download Paper]

Keywords: ChatGPT, Persuasion, Behavior change, Dietary interventions.

Abstract:

Abstract—The emergence of Large Language Models (LLMs) such as ChatGPT has led to applications like digital interventions across diverse domains, including digital dietary behavior change interventions (DBCIs). While various AI-based apps, web-based platforms, and gamified mobile applications have shown their effectiveness as persuasive tools for promoting dietary behavioral change, the capabilities of ChatGPT in this domain remain unexplored. This study examines qualitative responses from users informing the different persuasive strategies employed by ChatGPT in dietary management. Through a mixed study, we evaluated ChatGPT’s overall persuasiveness for diet management and user insights on the strengths and gaps of its use and persuasive capabilities. We recruited 17 ChatGPT-4 users and engaged them in interactions with AI-generated meal plans. Subsequently, they provided feedback through interviews and a perceived persuasiveness scale questionnaire. Our findings reveal that users generally perceive ChatGPT as persuasive in promoting healthy eating behaviors (p

<.006). Thematic analysis emerging from our interview transcripts showed that ChatGPT has implemented some persuasive strategies while indicating the need to include additional ones e.g. self-monitoring, reminders, and trustworthiness. Based on our findings, we contribute to the field by providing recommendations for developers on integrating additional persuasive strategies while considering the ethical implications of using LLMs for dietary management.>

1435 – AR-based Dancing Intervention for Physical Activity

Ifeanyi Odenigbo, Alaa Alslaity, Gerry Chan, Makuochi Samuel Nkwo and Rita Orji

[Download Paper]

Keywords: mobile health intervention, persuasive strategy, persuasive system design (PSD), augmented reality

Abstract:

The significance of physical activity (PA) in maintaining overall health and well-being is crucial, particularly in today's sedentary lifestyle and rising obesity rate. Participating in enjoyable activities such as dancing holds the potential to boost PA levels and positively impact one's mood. Technological advancements offer opportunities to enhance individuals' engagement in various physical activities. This study investigated the effectiveness of an augmented reality (AR)-driven persuasive intervention aimed at improving users' physical activity through dancing. To accomplish our objective, we developed ARDancee, a persuasive mobile health intervention that integrates Augmented Reality, Machine Learning, and persuasive technology to encourage adults to elevate their PA through dancing. A 15-day user study involving 104 participants revealed that the intervention successfully motivated participants' engagement in physical activity. The contribution of this work is twofold: (1) the design and evaluation of an AR-driven persuasive mobile app, and (2) the provision of insights and design recommendations.

1482 – Little Eyexplorer: A Serious Game for Pediatric Low Vision Rehabilitation

Ana Sofia Manco, Rita Paulete, Catarina Paiva, Miguel Castelo-Branco and Marco Simões

[Download Paper]

Keywords: Serious Games, Gamification, Visual Rehabili- tation, Human-Computer Interaction.

Abstract:

Abstract—Serious games offer a promising approach to pe- diatric low vision rehabilitation, particularly for children with Cerebral Visual Impairment (CVI), the leading cause of low vision in developed countries [2]. Traditional rehabilitation methods often rely on repetitive exercises that can become monotonous, reducing engagement and therapy adherence. With approximately 19 million children under the age of 15 affected by visual impairments worldwide [1], new solutions are needed to enhance motivation and effectiveness in therapy. By integrating game mechanics into therapeutic exercises, serious games have been widely applied in healthcare to improve motivation and engagement [3]. This study explores the develop- ment and evaluation of a game-based solution designed to support the visual rehabilitation of children with low vision, particularly those with CVI. The user experience was assessed by both therapists and children to ensure the application met their needs. Results from user testing indicate high usability and engagement, contributing to increased adherence to rehabilitation. Therapists found the application intuitive and adaptable to individual patient needs. However, limitations such as restricted eye tracker compat- ibility and a limited number of games highlight areas for future improvement. Despite these challenges, the findings support the potential of serious games in pediatric visual rehabilitation.

1535 – Gamified Interventions for Composting Behavior: A case study using the Gamiflow framework in a workplace setting

Ezequiel Santos, Geiser Chalco Challco, Cláudia Sevivas and Vítor Carvalho

[Download Paper]

Keywords: Gamification, Gamiflow Framework, Compost- ing Behavior, Workplace Sustainability, Behavior Change, Envi- ronmental Awareness

Abstract:

This study investigates the impact of a gamified intervention, inspired by the Gamiflow framework, on promoting composting behaviors in a workplace setting. Using a hybrid approach combining physical compost bins and a Slack-based gamified system, the intervention engaged 20 participants, with half assigned to a control group and the other half participating in the gamified program over three days. Results showed significant improvements in composting confidence among participants in the gamified program compared to the control group (t(18) = 4.05, p < 0.001). Although knowledge and motivation differences were not statistically significant (p > 0.05), a trend was observed for improved composting behavior (χ2 = 3.232, p = 0.072). Post-intervention, the Slack channel continued to serve as a space for discussions on composting and eco-friendly practices, highlighting its role in fostering long-term community engagement. Limitations such as the relatively small sample size and short duration suggest future research should explore long-term effects and larger-scale implementations.

1579 – Human-centred Artificial Intelligence: Pilot design of a Virtual Patient

Juliana Samson, Petros Lameras, Natasha Taylor, Nikki Holliday, Michelle Castleberry, Szabolcs Arnoczki and Rosie Kneafsey

[Download Paper]

Keywords: Artificial intelligence, Virtual patients, Co- creation, Healthcare simulation, Interprofessional education, Prompt engineering, Generative AI, Large Language Models.

Abstract:

Abstract—Virtual patient (VP) avatars driven by artificial intelligence (AI) could enhance healthcare training and offer flexible learning. Recent advances have developed large language models (LLMs) for more natural and contextual responses, but research into LLMs for VPs is still emerging. This research aimed to co-create prompts and training for a conversational AI system supporting a VP. The objective was to pilot the processes of prompt engineering and AI training in line with iterative development and human-centred design (HCD). Co-creation underpinned by design thinking was employed, involving collaboration between the university as User Experience designers and industry AI Engineers. Fifty-nine participants from student, academic, clinical, and technology groups were recruited for six co-creation workshops. Four versions of the VP prompts were developed and tested, with nine training samples included in the reinforcement fine tuning data set. This research adopts an HCD approach, outlining various techniques for co-creating optimal prompts that consider the VP’s personality, life context and clinical situation. A definition of VPs as it relates to human-centred AI (HCAI) development and a framework for the process is discussed.

1600 – Tu Jardín: A Serious Game for Intergenerational Bonding and Mitigating Acculturative Stress

Samantha Conde, Aviv Elor and Sri Kurniawan

[Download Paper]

Keywords: Serious Games, Acculturative Stress, Intergener- ational Communication, Latine Families, Mixed-Methods Study, Human-Computer Interaction

Abstract:

Acculturative stress creates barriers to mental health and intergenerational communication in Latine-American families. This paper presents a preliminary usability study of a serious game designed to address this challenge. Tu Jard ́ın, de- veloped using the Acculturative Game Design (AGD) framework and principles of Self-Determination Theory, fosters family dia- logue, empathy, and cultural understanding through interactive gameplay. A mixed-methods study with 8 participants (4 migrant- generation parents and their first-generation adult children) evaluated usability, engagement, and communication over two weeks. Results indicate high usability (UMUX = 85.71/100), strong autonomy (M = 6.33/7.00) and competence satisfaction (M = 6.00/7.00), and effectiveness in facilitating conversations about cultural and generational challenges. Participants reported high comfort discussing sensitive topics (M = 4.63/5.00) and increased empathy (M = 4.75/5.00). However, technological barriers for older users and pre-existing communication patterns influenced effectiveness. This study highlights the potential of serious games to address acculturative stress while emphasizing the need for age-inclusive and customizable designs. To support further research, we openly share the complete Unity project files and Figma design assets for adaptation and extension.

2018 – Game-Based Biofeedback Increases Subjective Ratings of Interoceptive Awareness

Grace Yat Sum Leung, Benjamin Cook, Lucie Daniel-Watanabe, Naresh Subramaniam, Johanna Finnemann, Toby Woolley, Craig Powell, Sergey Sitnikov and Paul Fletcher

[Download Paper]

Keywords: Biofeedback, games for health, interoceptive awareness, slow-paced breathing, virtual reality

Abstract:

Integrating human physiology into interactive computer environments, game-based biofeedback provides an intuitive platform to learn self-regulation through visualizing, monitoring, and modulating real-time biosignals. The present study presents a novel breath control biofeedback game aimed at enhancing interoceptive awareness–the ability to sense and appraise internal physiological signals–among adolescents and investigated potential differential effects between virtual reality (VR) and flat screen (FS) biofeedback. 45 participants experienced the biofeedback game to practice slow-paced breathing via VR and FS in a randomized order. Findings revealed significant increases in self-ratings of interoceptive awareness concerning the utility of bodily sensations, as well as interconnectedness of mental, emotional, and physiological processes for self-regulation. VR biofeedback may have conferred an added potential benefit through increases in attention regulation scores. While the effects of VR and FS biofeedback did not differ, the order of modality exposure influenced specific interoceptive outcomes. These findings demonstrate the potential of biofeedback games in enhancing interoceptive awareness, with clinical implications for improving emotion regulation and mental health.

2499 – AI-powered Interactive Dashboard: Using Machine Learning and Visual Analytics for Non-Cardiac Surgery Decision Support

Sussan Anukem, Lovelyn Ozougwu, Grace Ataguba, Evangelos Milios and Rita Orji

[Download Paper]

Keywords: Non-cardiac Surgery, Decision Support, Artificial Intelligence, Visual Analytics.

Abstract:

Clinical decision-making is often complex and time-consuming due to the large amount of required data, contributing to an increase in mortality rates, particularly in non-cardiac surgery cases. To address this problem, we present an interactive artificial intelligence (AI) dashboard that combines visual analytics (VA) and machine learning (ML) to facilitate quick decision-making and enhance patient care. Visual analytics makes use of human perceptual and cognitive capabilities to quickly process complex data for decision- making. Machine learning is used to predict patients’ states for quick decision-making. Though a lot of studies have emerged focusing on the application of VA for patient health care, such as diabetes and infectious diseases, little is known about its application to non-cardiac surgery. In this paper, we harness the capabilities of VA and ML to develop an interactive intelligent dashboard to enhance decision-making for non-cardiac surgery patients. This paper presents the design, development, and initial results of assessing the usability and usefulness of the dashboard with HCI experts and medical doctors. The results showed that users found the dashboard usable and useful. The qualitative analysis revealed six key themes, including the system's role in improving healthcare navigation and equity, its impact on patient-centered care delivery, and the ethical implications of predictive analytics in healthcare. We present our findings along with study limitations and future research directions.

2706 – A Proposal for a Mobile Application Pipeline for Posture-Based Muscle Rehabilitation at Home

Júlio Castro Lopes, Isaac Van-Deste and Rui Pedro Lopes

[Download Paper]

Keywords: Digital health technology, Tele-rehabilitation, Pose estimation, Home-based rehabilitation

Abstract:

Abstract—This work outlines the development process of a rehabilitation system from smartphones to provide remote moni- toring and real-time feedback assistance in muscle rehabilitation exercises. The system leverages advanced machine learning tech- niques, such as pose estimation techniques and anomaly detection models, in tracking users’ movements and assessing the perfor- mance of exercises. The system is designed to identify deviations from correct movement patterns and provide corrective feedback, allowing patients to engage in home-based rehabilitation without specialized hardware. This paper details the system design, data acquisition methods, and the machine learning models used to detect incorrect movements. The outlined pipeline is intended to facilitate the creation of an affordable, cost-effective, and scalable rehabilitation platform for strengthening patient adherence to exercises and optimizing recovery outcomes.

2709 – Towards a Methodology for using EEG Motor Imagery to control Video Games

Francesco Moschella, Nicola Del Giudice, Michele Loreti and Hannes Högni Vilhjálmson

[Download Paper]

Keywords: brain-computer interface, real-time, motor im- agery, signal classification, deep learning

Abstract:

Nowadays, enhancing the quality of life for individ- uals with reduced mobility or physical disabilities is a crucial challenge. In recent years, new technologies and techniques, such as Brain-Computer Interfaces, have emerged as viable solutions. The research has focused on developing applications and devices to help people complete everyday tasks autonomously. These tools reduce the need for external caregivers. In this work, we present three main contributions: a near-real-time Electroencephalography Motor Imagery classification system, a pipeline that integrates the classification system and seamlessly controls external devices or applications via WebSockets and a Generative Adversarial Network to perform data augmentation and allow rapid and efficient testing. We will also present a virtual environment that we used to test the pipeline usability in real-world case scenarios. Our work, while being a proof of concept and an initial study shows promising results in terms of accuracy, resource efficiency and latency, outperforming the systems and models found during the literature review in terms of EEG recording duration, with comparable accuracy.

2781 – Red Flagging of Patient Data in the Emergency Room: A User-Centered Design

Inga Müller, Jasmin Henze, Sora Enders-Comberg, Ole Mølgaard, Lars Ganzhorn Knudsen, Lena Hegel and Alina Huldtgren

[Download Paper]

Keywords: Red Flagging for Emergency Treatment, User- Centered Design, Usability Testing, Interactive Prototyping, Clinical Decision Support

Abstract:

Emergency departments (EDs) are high-pressure environments where factors like rapid decision-making, overcrowding and resource constraints can lead to errors and reduction in the quality of provided care. At the Aarhus University Hospital (AUH) in Denmark, patient data such as medical history is collected on a large scale and made available digitally through an Electronic Patient Journal (EPJ) to enhance overall patient care. However, the volume of data poses challenges for the medical staff in the ED, necessitating efficient ways to filter critical information. In this context, this paper describes the design of an application for "red flagging", which will later be developed using Artificial Intelligence (AI). Its goal is to identify critical patient information and highlight potential risks that might otherwise be overlooked by the ED’s medical staff. This research examines the topic from the user's perspective, exploring different methods to incorporate a red flagging system into existing healthcare workflows. The primary focus is on investigating the potential design and visualization of the red flagging functionality to ensure that the information delivered by the AI will benefit the ED staff. In this context, a user-centered design process was implemented, resulting in the creation and evaluation of a design prototype. This prototype serves as a practical exploration of how such an application can be tailored to meet the needs and requirements of its users while aligning with existing systems. It also gives an outlook on the potential of integrating such systems, as well as the concerns and requirements that must be addressed to implement AI-based software into clinical practice.

3043 – A Research-Oriented Platform for Standardized Executive Function Assessment and Training in Children

Matheus Felizardo, Nuno Rodrigues, Sónia Sousa, Eva Oliveira, Adriana Sampaio and António Coelho

[Download Paper]

Keywords: Executive functions, cognitive assess- ment, children, digital platform, timeline-based archi- tecture, Human-Computer Interaction.

Abstract:

Executive functions (EF) such as inhibitory control, working memory, and cognitive flexibility are critical for child development and academic readiness. However, the tools available for assessing and training EF in children often lack standardization, ecological validity, and accessibility. This paper presents CAPE- KIDS, a modular, research-oriented platform designed to support the creation, execution, and analysis of cognitive experiments and training protocols for children. The system is structured around timelines that organize tasks into configurable sequences and includes both backend (NestJS) and frontend (React/TypeScript) components optimized for non-technical researchers. We describe the architecture, database schema, and user interface, as well as results from expert interviews that guided design decisions and validated usability. CAPE- KIDS enables researchers to deploy standardized tasks, analyze behavioral data, and adapt training flows with visual logic blocks. Future developments include richer data visualizations, integration with neurophysiological tools, and deployment in real-world experimental stud- ies.

3207 – Etherea: a Video Game for Individuals with Motor Disabilities with Eye-Tracking-Based Interaction

Susanna Brambilla, Marco Ligabue, Giuseppe Boccignone, Nunzio Alberto Borghese, Laura Anna Ripamonti and Edoardo Carrer

[Download Paper]

Keywords: Eye-tracking, Electrodermal Activity, Video Game Interaction, Serious Games, Arousal

Abstract:

Accessibility in video games is essential to enable people with severe motor impairments to engage in interactive experiences. Traditional input methods, such as controllers and keyboards, create barriers for these players, requiring alternative interaction techniques. This paper presents Etherea, a video game that uses eye-tracking technology as the primary input method, allowing players with limited mobility to navigate and interact within a 3D environment. To evaluate user engagement and responsiveness to in-game stimuli, a case-study research was conducted on an individual affected by Spinal Muscular Atrophy (SMA). Adolescents with SMA often face limited gaming options, as few 3D games are developed with their unique needs in mind, given the condition’s short life expectancy. ElectroDermal Activ- ity (EDA) data was collected using a medical-grade wrist-worn device. Heatmaps were generated to visualize these physiological responses, providing insight into the emotional and cognitive engagement of the player. The findings highlight feasibility, potential, and challenges of real-time gaze-based interaction when individuals with severe motor impairments are involved.

3217 – From the Gym to the Jungle: Exploring User Perceptions, Needs and Experiences of Virtual Green Exercise

Misbahu Zubair, Muhammad Atif Ur Rehman and Jianquan Cheng

[Download Paper]

Keywords: Virtual Reality, Green Exercise, Metaverse, Virtual Exercise, Immersive

Abstract:

This paper explores infrequent Virtual Reality (VR) users’ perceptions, needs and experiences of immersive virtual green exercise. Virtual green exercise involves physical activity in simulated natural environments, offering potential psychological and physiological benefits similar to traditional green exercise. Participants engaged in physical activities in both immersive virtual indoor and outdoor/green environments, with focus group discussions before and after. Findings indicate that participants valued the motivational and engaging qualities of green exercise and viewed VR as a potential tool for simulating exercise in virtual natural environments. Participants also recognised VR’s potential to overcome physical barriers to green exercise while offering additional benefits through digital immersion. However, some limitations and concerns were raised, prompting recom- mendations for improvements in hardware, software, activities, and environment design to better address these issues. This paper contributes to the body of research on immersive virtual green exercise by providing insights into the perceptions and experiences of infrequent VR users, while identifying user needs, preferences and potential areas for improvement.

3485 – Journaling for Digestive Health: A Self-Tracking Approach to Identifying Intolerances and Triggers

René Baranyi, Tina Stamencic, Christoph Aigner, Sylvia Winkler, Carina Arnberger and Thomas Grechenig

[Download Paper]

Keywords: intolerances, journaling, gamification, mhealth

Abstract:

Many individuals struggle to identify food intoler- ances and gastrointestinal triggers due to inaccurate, incom- plete, and disorganized tracking methods. Traditional food and symptom journals are often burdensome, unreliable, and lack meaningful information, making it difficult for users to recognize patterns and take action. This paper introduces Digesty, a gamified digital journal user interface prototype that streamlines symptom tracking by offering structured input, various tracking options, and a focus on mindful eating. The methodology includes literature research, user feedback, and semi-structured inter- views, guiding an iterative 4-phase design and evaluation process to refine usability and effectiveness, identifying 34 requirements of such a solution. The results demonstrate that a solution like Digesty could improve the accuracy, organization, and user engagement of the tracking, addressing key limitations of existing solutions. This work provides a user-centered and practical approach to food and symptom tracking, contributing to the development of more efficient digital health tools to manage individual digestive health.

3614 – Serious Games and Health: Bibliometric Trends from SEGAH (2011–2024)

Ezequiel Santos and Vítor Carvalho

[Download Paper]

Keywords: Bibliometrics, SEGAH, Serious Games, Health Applications, Scientific Trends

Abstract:

"The Serious Games and Applications for Health (SEGAH) conference, established in 2011, has become a central venue for research on serious games, virtual reality, and gami- fication in health-related applications. This bibliometric analysis examines publication trends, citation patterns, keyword evolution, and geographic contributions across 12 editions of SEGAH (2011–2024). A total of 502 papers authored by 1,606 contrib- utors were analyzed using a custom Python-based pipeline that leveraged libraries such as pandas, networkx, matplotlib, and seaborn, as well as APIs from IEEE, Crossref, and OpenCitations. Results show a steady growth in publications, with notable peaks in 2017 and 2023. The total citation count ranges from 2,045 to 2,373 depending on the data source, as values differ across IEEE, Crossref, and Google Scholar. The most cited papers focus on serious games for health applications, brain- computer interfaces, and virtual reality-based training. While earlier papers have had more time to accumulate citations, recent years (2023–2024) show a higher percentage of non-cited papers. Keyword analysis reveals that Serious Games is the most frequently occurring research theme (148 occurrences), followed by Virtual Reality (85) and Rehabilitation (36). The geographic dis- tribution highlights Portugal as the leading contributor, followed by Brazil, Canada, and Australia, with increasing participation from European and Asian countries. Collaboration networks show strong interdisciplinary cooperation across institutions. These findings provide a comprehensive overview of SEGAH’s research landscape and its evolving contributions to serious games in healthcare."

3924 – MoodSyncs: Investigating Physiological Synchrony Through Collaborative Gameplay

Rita Paulete, Daniela Sousa, Daniel Agostinho, Miguel Castelo-Branco and Marco Simões

[Download Paper]

Keywords: Physiological Synchrony, Autism Spectrum, Biosignals, Serious Games

Abstract:

To lead healthy and fulfilling lives, humans rely heavily on their social skills. As such, a severe deficit in social competencies can lead to mental health issues, including depression and anxiety. As social difficulties represent one of the core deficits in the Autism Spectrum (AS), this population is particularly vulnerable to this reality. That is why it is necessary to develop accessible and personalized solutions for social skills training in autism that can reach the biggest number of individuals in this population. In this paper, we propose a solution designed to address this demand. A collaborative serious game that we have called MoodSyncs. In this game, we ask the players to synchronize the continuously varying facial expressions of two avatars by independently controlling the speed of each one of them. While playing, a set of multimodal biosignals are simultaneously acquired from the players. We present a preliminary analysis of the physiological synchrony (PS) emerging between dyads during gameplay and its relationship to the individuals’ self-perception of interpersonal connectedness during the game. The results have uncovered some emerging dynamics in PS during gameplay and an interesting relationship between the dyads’ PS and their reported sensation of interpersonal connectedness.

4213 – Which part makes it work? Mechanism exploration through feature comparison in a healthcare-related serious game

Pat Healy, Isabelle Malizio, Angeline Pho, Kai-Lin You, Andrew Xu, Teresa H. Thomas and Dmitriy Babichenko

[Download Paper]

Keywords: serious games, self-advocacy, cancer, feature evaluation, failure, point-of-view, feedback

Abstract:

Evaluating serious games in healthcare has always, justifiably, focused primarily on efficacy, leaving researchers to speculate as to why a given serious game ”works” when evidence of efficacy arises. Our work pushes beyond this speculation through a study that attempts to clarify the mechanism that drives the efficacy of a patient-centric narrative serious game named Strong Together. Through a randomized experiment across four groups, corresponding with four distinct versions of the game with individual gameplay features modified, we evaluate the impact of three common gameplay features present in Strong Together: ”soft” fail states, implicit audio-visual feedback, and a third-person narrative perspective. Based on pre and post- test questionnaires and gameplay analytics captured for 190 participants, we found in the case of Strong Together that feedback mechanisms, failure conditions, and player perspec- tives significantly influenced player engagement, decision-making times, and self-advocacy knowledge retention.

4524 – The Effect of Multiplayer Game Modes on Inter-Player Data for Player Experience Modelling

Alexander Brooke, Matthew Crossley, Huw Lloyd and Stuart Cunningham

[Download Paper]

Keywords: multiplayer, emotion, experience modelling

Abstract:

Research into social compliance, emotional conta- gion and behavioural synchronicity shows promise for various avenues of work concerning human-computer interaction, and a wider understanding of emotion. Despite their relevance, few studies have applied findings from these domains to player experi- ence modelling in a multiplayer game, in itself having applications in entertainment, education and healthcare. Further to this, of the little work making use of inter-player data to model aspects of player experience, none considers the differences that may be found across common multiplayer game modes. This work therefore makes use of data collected across players in a series of common multiplayer game modes, considering the utility of inter-player data for predictive modelling using artificial neural networks in each. Results suggest that approaches modelling measures of players’ experiences in terms of discrete emotion intensities are best made using their own facial expressions in nearly all circumstances, but past this, facial expression data from team based and competitive game modes shows the greatest promise. Considering the additional data separations available to team-based gameplay, we find that data collected from players on an opposing team shows greater utility for prediction of target player experience than data collected from a player on the same team. Regarding this, we make suggestions for the most applicable avenues for future research into the utilisation of inter-player data for emotional modelling.

5565 – Co-design of a Mixed Reality application to support Freezing of Gait Rehabilitation

Eleonora Chitti, D. Andrea Montereale, Angelica De Sandi, Enrico Mailland, Linda Borrellini, Filippo Cogiamanian, Denise Mellace, Angelica Marfoli, Carmelo Campo, Carlo Manzoni, Roberta Ferrucci and N. Alberto Borghese

[Download Paper]

Keywords: Mixed Reality, Freezing of Gait, Parkinson’s Disease, Digital platform for rehabilitation, Virtual Cueing, Co- design

Abstract:

Freezing of Gait (FoG) is a common motor impair- ment in Parkinson’s disease, affecting mobility and increasing fall risk. Traditional rehabilitation methods using physical therapy and, visual or auditory, cueing have demonstrated benefits but can be limited in adaptability and accessibility. Recent advance- ments in Mixed Reality (MR) provide new opportunities for reha- bilitation. MR preserves spatial awareness by integrating digital elements into the real world while offering real-time adaptability in therapeutic settings. This study presents a co-designed MR rehabilitation platform with training exercises for FoG therapy. The system comprises an Oculus Quest 3 application and a Companion tablet app for real-time exercise personalization and cue activation. Nine medical professionals were involved in the whole process and two patients with Parkinson’s disease were involved in refining the platform. Three iterative workshops led to key refinements enhancing usability. Initial sessions defined core FoG rehabilitation needs addressed with two exercises: obstacle avoidance and corridor crossing, and through the design of visual and auditory cues to help patients in training. Usability improve- ments included a Companion tablet app for real-time exercise customization, refined and personalized cueing. These updates reduced discomfort and enhanced adaptability in rehabilitation. This study highlights the potential of MR for FoG rehabilitation and presents a system that supports real-time adaptive cueing. Future research should explore a wider usability study, and the implementation of additional cueing techniques to address diverse patient needs across different stages of FoG.

5828 – Understanding Factors Affecting Player Experience and Enjoyment in Virtual Reality Games

Misbahu Zubair, Connah Kendrick and John Henry

[Download Paper]

Keywords: Games, Virtual Reality, VR, Genre, Player Experience, PX, Usability, PXI, Enjoyment, UX, User Experience

Abstract:

Virtual Reality (VR) games offer immersive ex- periences with the potential for significantly higher levels of Enjoyment to players; however, the factors influencing Player Experience (PX) in commercial VR games remain underexplored. Our study employs an empirically validated PX measuring tool, the Player Experience Inventory (PXI), to gather self-reported data from VR players (n=109) and investigate the effects of game genre, play style, VR devices, and input methods on PX in VR games. Results indicate that genres have different effects on PX; for example, horror and adventure were found to positively affect Curiosity, simulation was found to contribute to Autonomy, while RPGs were found to negatively affect Ease of Control. Differences in reported experience across VR headsets and play- styles were also found, with higher levels of Immersion reported in newer or more advanced headset models, and sitting play-style associated with more Meaning than other play-styles. Our study also identified the PXI constructs and factors that contribute to Enjoyment in VR games. Overall, this study advances the existing knowledge on PX in VR games and offers actionable insights for both VR game designers and researchers for improving and assessing PX.

6003 – A Serious Game for Bone Cancer Awareness and Education: Integrating Simulated User Feedback for Preliminary Validation

Leonardo Gonçalves Marques, Juliana Amaral de Figueiredo, João Vitor Vieira Lira and Maria Andréia Formico Rodrigues

[Download Paper]

Keywords: serious games, educational, health, bone cancer, simulated user feedback

Abstract:

This study presents CancerSB, a serious adventure game developed to raise awareness about bone cancer through an engaging, point-and-click experience. Players explore culturally themed levels—Chile, Italy, and China—each symbolizing bone regions affected by cancer, solving puzzles, collecting items, and simulating treatment decisions. The game integrates original art, narrative, and educational content, and was developed with medical input to ensure accurate bone cancer representation. To evaluate early design choices, we used ChatGPT to generate simulated feedback from diverse user personas, following the “mega-personas” approach. Results suggest consistent positive reception across personas, particularly for visual design, cultural sensitivity, and educational value. These findings serve as a pre- liminary validation and demonstrate the value of this approach for guiding design improvements prior to user testing.

6150 – Drone-Based Spatial Gait Analysis in an Urban Park Across Age Groups Using a Deep Learning Approach

Lian Duan, Jianquan Cheng, Shiqi Huang, Xuancheng Long and Ling Li

[Download Paper]

Keywords: Gait Spatial Analysis; Drone-based Gait Information Extraction; Gait Analysis across Age Groups; Trajectory Analysis; UAVs

Abstract:

This study introduces a pioneering drone-based spatial gait analysis approach for scalable and ecologically valid urban health monitoring. Leveraging a processing pipeline integrating Drone-YOLO for object detection, YOLOv11-pose for pose estimation, ByteTrack for multi-object tracking, and geographical coordinate mapping, we achieved high-fidelity extraction of pedestrian keypoints and trajectories from drone imagery. Rigorous testing on 1679 pedestrians across age groups in Qingxiu Mountain Park, Nanning, China, revealed significant inter-group differences in gait speed, trunk inclination, and stride length variability. Spatial analysis highlighted elevated gait speeds in open, flat areas of the Main Gate Plaza, contrasting with significantly reduced speeds in congested, topographically complex Flower Plaza. "Cold spots" of gait speed, coinciding with high pedestrian density and uneven terrain, were identified in Flower Plaza, while "hot spots" were observed in open pathways of the Main Gate Plaza. These findings demonstrate the transformative potential of drone-based spatial gait analysis for urban health surveillance, evidence-based urban planning, and understanding the complex interplay between human movement, health proxies, and urban environments. Future research should enhance pipeline robustness in occluded urban settings and explore multi-modal sensor fusion to refine dynamic walking behavior analysis from aerial perspectives.

6356 – Game-Based Handwriting Training: Exploring Serious Games with the SensoGrip System

René Goldschmid, Stella Sofia Gross, Nadine Kirnbauer, Gernot Korak, Matthias Nagl, Bernhard Taufner and Lena Rettinger

[Download Paper]

Keywords: Game-based learning, serious games, fine motor skills, input devices, handwriting training, game mechanics.

Abstract:

Fine motor skill development is essential for chil- dren’s academic and cognitive growth, particularly in relation to handwriting. However, traditional training methods may lack engagement and adaptability, especially for children with motor difficulties such as dysgraphia. This study presents the design, implementation, and pilot evaluation of serious games developed using the SensoGrip system—a pressure-sensitive pen equipped with multiple sensors for real-time motor skill tracking. Building upon prior research in occupational therapy and sensor- based feedback, sensor data received from the SensoGrip is integrated into custom-designed mini-games built in the Unity engine. These games leverage pressure, tilt, and motion input to create interactive mechanics that promote controlled pen use and motor coordination. The paper outlines a structured development process and details how sensor inputs were mapped to gameplay elements to ensure educational relevance and intuitive usability. A pilot test with preschool children provided insights into user comprehension, motor skill limitations, and the need for intuitive feedback design. The results highlight the potential of sensor- integrated serious games as engaging tools for early handwriting intervention and motor training, while also identifying areas for future refinement and broader empirical validation.

6646 – Leveraging Serious Play to Foster Learning and Action on Sustainable Development Goals

Larissa Gurjão Pereira de Lima, Renato Yshihara Fujie, Vinicius Bernades Pinto, Cristofer Henrique de Souza and Maria Andréia Formico Rodrigues

[Download Paper]

Keywords: games for change, learning, collaboration, SDG

Abstract:

This paper presents the development and early vali- dation of an innovative Games for Change platform aligned with the Sustainable Development Goals (SDGs). Designed to engage players in tackling socio-environmental and health challenges, the platform integrates interactive, challenge-based learning and gamified mechanics to promote sustainable practices. Developed in Unity, the platform combines 3D and 2D assets with a scalable backend powered by MySQL, PHP, Firebase, and Azure Database for MySQL. It supports real-time feedback and runs on PC, web, and mobile devices. Early validation through comprehensive testing has confirmed core functionalities such as authentication, interface navigation, and in-game interactions. Initial evaluations with educational institutions and industry partners suggest that the platform effectively fosters critical thinking, collaboration, and behavior change towards sustain- ability. These findings highlight its potential as a valuable tool for academic and corporate training in the context of Games for Change.

7041 – Designing Immersive Healing: Exploring Extended Reality Game-Based Intervention Elements for Mental Health

Franz Coelho and Ana Maria Abreu

[Download Paper]

Keywords: extended reality, game, mental health, anxiety, depression, stress

Abstract:

This study builds on a previous umbrella review that highlighted the effectiveness of combining Extended Reality (XR) and Game-Based Interventions (GBI) in mental health treatment, showing positive results in reducing anxiety, depression, and stress. XR included augmented, virtual, and mixed reality, while GBI encompassed serious games, gamification, game-based learning and training, exergames, and commercial video games. The review analyzed 201 studies and selected 16 (nine meta-analyses, six systematic reviews, and one scoping review). Given the role of design in digital mental health solutions, here, we conducted a reverse engineering analysis to understand how these interventions worked by reviewing descriptions and visual representations from each study, breaking down XR-GBI into core game elements. This allowed us to identify design features and motivational purposes linked to their effectiveness, as well as underused elements to inform future research and innovation. Frequently used game elements included "Emotions", "Single-player", "Consequence", "Simulation", "Customization", "Meaning", "Level", "Exploration", "Narrative", and "Feedback". The knowledge of frequent and underused game elements offers insights to advance XR-GBI design knowledge and support their use in digital mental health to boost intrinsic motivation, supporting cognitive and behavioral change. However, the absence of multiplayer features reveals a research gap, suggesting XR-GBI could be improved by adding cooperative, competitive, or collaborative elements. Future research and interventions should build on the game elements identified here to enhance mental health outcomes while exploring new elements, particularly social dynamics, to strengthen engagement and therapeutic impact.

7581 – Minecraft Serious Play: Adaptation of a Positive Psychology Task in the Minecraft Metaverse

Sabrina Bartolotta, Marta Pizzolante, Anastasia De Giovanni, Lorenzo De Angeli and Andrea Gaggioli

[Download Paper]

Keywords: Positive Technology, Best Possible Self Task, Digital Well-being, non-immersive VR, Metaverse

Abstract:

This study examines the digital adaptation of the Best Possible Self task within the Minecraft Metaverse, applying the Positive Technology framework. The objectives were to (I) assess the effects of the metaverse-based Best Possible Self on optimism and positive emotions, and (II) evaluate participants’ user experience with Minecraft as a psychological intervention tool. 22 participants completed the Best Possible Self task in Minecraft, with pre- and post-task assessments measuring optimism, affective states, and user experience. A behavioral measure was included: after the task, participants could enter a lottery, with their choice serving as a proxy of optimism and risk-taking tendencies. The findings suggest that the digital Best Possible Self task successfully preserved its psychological benefits. Post-task assessments revealed increased optimism, elevated positive affect, and a reduction in negative affect. Participants also reported a positive and engaging experience within the Minecraft Metaverse. 14 out of 22 participants opted into the lottery, and 10 of them expressed confidence in winning, further supporting the task’s influence on optimism. These results support the feasibility and effectiveness of the digital transposition of the Best Possible Self task, aligning with the framework of Positive Technology.

7732 – Boozy Gears: A Persuasive Game for Discouraging Drunk Driving

Soham Sen, Oladapo Oyebode, Chinenye Ndulue and Rita Orji

[Download Paper]

Keywords: persuasive technology, persuasive games, serious games, drunk driving, health, well-being, awareness,

Abstract:

Persuasive games have emerged as powerful tools for motivating behaviour change across diverse domains. In this research, we design, develop, and evaluate a persuasive game (Boozy Gears) that discourages drunk driving. Through a fusion of persuasive strategies based on the Persuasive Systems Design model, narrative episodes and immersive gameplay mechanics, the game aims to motivate behaviour change by challenging players’ perceptions and fostering empathy. We conduct a pilot user study with 31 participants to evaluate the perceived persuasiveness of the game and assess players’ subjective experiences using the Intrinsic Motivation Inventory scale. Our results show that the overall game and its five persuasive strategies are perceived as significantly effective in motivating behaviour change with respect to drunk driving. In addition, all four player-experience measures receive significantly high ratings. Based on our findings, we offer design recommendations and discuss the implications of Boozy Gears as a novel persuasive game for discouraging drunk driving.

7858 – Design, Implementation and Evaluation of a Gamified Mobile App for Long-Term Behavior Change

Christoph Aigner, Vanesa Basheva, René Baranyi, Carina Arnberger, Sylvia Winkler and Thomas Grechenig

[Download Paper]

Keywords: ncd prevention, gamification, behavior change, mobile health

Abstract:

The prevalence of non-communicable diseases (NCDs) is increasing. NCDs, such as cardiovascular diseases, cancers, diabetes, and chronic respiratory diseases, are not conta- gious but are typically caused by unhealthy behaviors. However, many of these diseases are largely preventable. Research shows that 80% of heart diseases, strokes, and type 2 diabetes, as well as over one-third of cancers, can be prevented by eliminating tobacco use, adopting a healthy diet, maintaining good mental health, staying physically active, and reducing harmful alcohol consumption. For many individuals, changing behavior to min- imize the aforementioned risk factors can be challenging and often leads to short-term results only. Previous research in NCD prevention has mainly focused on developing interventions that target specific behavior categories in isolation, disregarding the interconnected nature of human behavior, where improvements in one area can influence others. This work proposes a novel and holistic approach that acknowledges the complexity and interdependence of multiple factors influencing behavior change. The result is a gamified mobile app designed and developed to support long-term behavior change. A psychologist and a total of 25 members of the target group evaluated the application during different stages of development. The mobile app promotes positive attitudes toward behavior change, offering rewards for healthy actions and engaging users through a meaningful narrative, which enhances the effectiveness of interventions aimed at reducing NCD risk factors.

8082 – Sex-Educated: A Mobile Health App to Promote Sexual Health in Indian Communities

Pratyasha Bhattacharya, Gerry Chan, Makuochi Nkwo and Rita Orji

[Download Paper]

Keywords: Behavior change, mobile health (mHealth), sexual health, persuasive technology, serious games

Abstract:

Sex education plays an important role in developing a comprehensive understanding of sexual health, and empowering individuals to make responsible choices. However, in countries like India, sex education is often neglected due to societal stigma surrounding discussions about sex. This lack of proper sexual health knowledge frequently leads to risky sexual choices. We present Sex-Educated, a theory-driven, persuasive mobile application specifically designed to promote sexual health awareness among Indians. The app aims to increase knowledge about healthy sexual behavior and encourage changes in risky sexual behaviors. A quantitative study of 46 participants who used the app for 7 days and completed a questionnaire about their experience followed by an interview with 21 participants to uncover more qualitative insights. Results showed a positive change in sexual behavior and knowledge of sexual health. Based on our findings, we offer recommendations for designing mHealth interventions that improve knowledge and awareness within underserved populations.

8628 – Extending Digital Phenotyping Analysis with Contextual Data in mHealth Applications for Bipolar Disorder People

Abel González Mondéjar, Lívia Lutz dos Santos, Greis Francy Mireya Silva-Calpa, Elie Cheniaux and Daniel Correa Mograbi

[Download Paper]

Keywords: digital phenotype, bipolar disorder, contextual data.

Abstract:

Bipolar disorder is a complex and severe mental illness characterized by fluctuations in mood from depressive to manic states and periods of stable mood, affecting around 2% of the world’s population. As mental health monitoring of those fluctuations is sensitive, digital phenotyping uses active and passive data from self-related forms and cellphone sensors. However, contextual data (e.g. weather and social factors) remain underexplored. This paper aims to analyze the impact of contex- tual variables and their influence on bipolar disorder and propose a framework for their integration into digital phenotyping. To achieve this goal, we performed a literature review and eight expert interviews in a semi-structured interview. As a result, contextual data significantly influenced mood fluctuations in bipolar patients and improved clinical decision making. This article shows that the integration of contextual data complements the analysis of digital phenotyping and should be considered in future mHealth applications.

9114 – Origin Realm: A Virtual Reality Mindfulness Serious Game Based on Immersive Training Theory

Yuqing Chen, Zitai Xiao and Shiguang Ni

[Download Paper]

Keywords: Virtual Reality, Mindfulness, Serious Games, Psychological Intervention.

Abstract:

Abstract—This study presents Origin Realm, a novel virtual reality (VR) mindfulness serious game based on immersive train- ing theory that addresses limitations in traditional psychological interventions. The research integrates gamification principles, multiplayer functionality, and multimodal feedback mechanisms to enhance mindfulness practice accessibility and effectiveness. A comprehensive framework was developed incorporating four pro- gressive levels: mindful stretching, loving-kindness meditation, art therapy, and eye-movement mindfulness, each designed with specific interaction mechanisms and feedback systems. A ran- domized controlled trial compared individual VR mindfulness, group VR mindfulness, and traditional mindfulness interventions. Results demonstrated that Origin Realm significantly improved positive affect, mindfulness levels, and attentional performance. This research contributes to the emerging field of VR-based psychological interventions by empirically validating the efficacy of immersive, gamified mindfulness training and establishing design principles for future applications that balance individual autonomy with social interaction benefits.

9953 – Usability of a Virtual Reality Intervention Combining Cognitive-Behavioral and Grief Therapy for Psychological Support Following Miscarriage

Diana C. G. Mendes, Rita Costa, Ana Fonseca and Mónica S. Cameirão

[Download Paper]

Keywords: miscarriage, emotions, adaptation, usability, presence

Abstract:

Miscarriage, the involuntary fetal death before the 20th week of gestation, is a common event that can result in negative mental health responses. In Portugal, symptoms of psychological morbidities have been reported by nearly half of women who suffered a miscarriage. Still, very few reported being offered psychological support although in need of immediate support. Considering the lack of health practitioners worldwide, Virtual Reality (VR) is a valid alternative for psychological support in this context. We present a multi- scenario VR system that leverages traditional protocols from Cognitive- Behavioral and Grief therapy to deliver a preventive intervention targeted at miscarriage. We ran a user study to evaluate usability and presence of tasks that address emotions, social support, and adaptation to the loss. We measured presence and usability, and conducted a thematic analysis on the qualitative data gathered. The results showed that the scenarios provided adequate levels of positive factors of presence, low negative effect, and above-average usability. Users’ feedback highlighted high immersion and feelings of embodiment with their avatar. However, difficulties when writing on a virtual keyboard, controller settings and visual cues are amongst the issues that need improvement.

## Poster Presentations

193 – Motivating Physical Activity through Location-Based Augmented Reality Exergames: A Review of Trends and Design Opportunities

Priyal Srivastava, Gerry Chan, Alaa Alslaity, Makuochi Nkwo and Rita Orji

[Download Paper]

Keywords: Augmented reality (AR), exergame, physical activity, motivation, persuasive strategies

Abstract:

Abstract—Physical inactivity and a sedentary lifestyle have become significant health issues, requiring creative approaches to encourage physical activity (PA). In recent years, there has been increased research attention on the role of exergames for promoting PA and keeping an active lifestyle. In this paper, we provide an overview of existing studies within the last 10 years on location-based augmented reality (AR) exergames aimed at promoting PA. We reviewed 22 papers from 6 major electronic databases that met the inclusion criteria. Our results show that (1) location-based AR exergames are effective and able to promote PA in an engaging and enjoyable way, (2) various aspects motivate people to start playing exergames, including competitive features, enjoyment, augmented reality features, curiosity, and social interactions, (3) boredom or a lack of new content was an important demotivating factor for quitting, and (4) competition emerged as the most heavily used persuasive strategy in location- based exergames that promote PA. We propose practical recommendations to design exergames that offer captivating and immersive experiences, ultimately promoting PA and addressing the growing public health concern of sedentary lifestyles.

243 – Serious Games for Emotion Regulation in Children: A Systematic Review

Bárbara Carvalho, Eliana Silva and Luís Paulo Reis

[Download Paper]

Keywords: systematic review, serious games, emotion reg- ulation, game design, children

Abstract:

Abstract—Research has increasingly highlighted the impor- tance of emotional knowledge and emotion regulation (ER) skills in the socio-emotional development of school-age children. The persistence of ER difficulties can predict psychological problems such as anxiety and depression, accentuating the need for innovative solutions to teach ER to children. Serious games (SGs) have emerged as a dynamic and creative tool to educate, train, or raise awareness about specific topics, particularly in children’s mental health. To the best of our knowledge, this study presents the first systematic review focused specifically on the key design elements of SGs targeting ER for children, addressing a gap in previous research, which has only explored their efficacy with a brief overview of design elements. Following PRISMA guidelines, a search across multiple databases collected 16 articles for analysis and summary. The analysis revealed that while the number of SGs remains limited, key design patterns, such as real- life scenario simulations and progression systems are frequently employed to enhance engagement, and the transfer of virtual to real-world ER skills.

245 – Designing Serious Games to Support Teachers’ Emotion Regulation: A Systematic Review

David Fang, Eliana Silva and Luís Paulo Reis

[Download Paper]

Keywords: systematic review, serious game, emotion regu- lation, game design, teacher

Abstract:

Abstract—Emotion regulation (ER) is critical for elemen- tary teachers’ well-being and classroom effectiveness, yet many struggle with ER due to high stress and emotional demands. Serious games (SGs), designed for educational purposes, offer a promising, interactive approach to improving ER skills by simulating real-world scenarios in a safe, engaging environ- ment. This systematic review, conducted in accordance with the PRISMA guidelines, examines existing research on game design principles for SGs targeting ER in elementary teachers. Databases including IEEE, PubMed, ScienceDirect, and Web of Science were systematically searched, yielding 8 relevant records, with an additional 2 records identified from other sources. The usage of SGs demonstrated promising results in supporting the target audience. However, the limited number of studies highlights a significant research gap, particularly in co-design approaches, as few involved teachers in the development process. These findings suggest that SGs hold potential for enhancing ER skills and classroom dynamics, but further research is needed to establish a general design framework and ensure practical relevance for educators.

1773 – Serious Games for Food Waste Reduction: A Qualitative Review

Ezequiel Santos, Cláudia Sevivas, Vítor Carvalho, Nuno Feixa Rodrigues and Eva Ferreira Oliveira

[Download Paper]

Keywords: Serious Games, Food Waste, Behavioral Change, Educational Technology.

Abstract:

Serious games provide interactive learning experi- ences that promote behavioral change in sustainability chal- lenges, including food waste reduction. This study presents a qualitative review of nine serious games designed to influence food waste behaviors. Using the Playful Learning Framework, the review synthesizes research on game mechanics, educational approaches, and behavioral outcomes. Findings indicate that serious games improve food storage knowledge, enhance meal planning, and foster waste-conscious behaviors. However, gaps remain in long-term retention, community-driven engagement, and cross-platform effectiveness. Future research should explore multiplayer interaction, policy-driven applications, and longitu- dinal assessments to evaluate sustained behavioral change.

2786 – Designing Virtual Reality Games for Grief: A Workshop Approach with Mental Health Professionals

Amina Kobenova, Piper Stickler, Thais Alvarenga and Sri Kurniawan

[Download Paper]

Keywords: Virtual Reality, Grief, Serious Games, Mental Health

Abstract:

Although serious games have been increasingly used for mental health applications, few explicitly address coping with grief as a core mechanic and narrative experience for patients. Existing grief-related digital games often focus on clinical training for medical professionals rather than immersive storytelling and agency in emotional processing for the patient. In response, we designed Road to Acceptance, a VR game that presents grief through first-person narrative and gameplay. Ten pilot testers—eight students and two mental health professionals— evaluated its usability and intervention potential. As the next phase of evaluation, we propose a workshop-based study with licensed mental health professionals to assess the therapeutic impacts of the game and alignment with best practices in grief interventions. This will inform iterative game design and patient evaluation methods, ensuring that the experience is clinically appropriate. Potential findings can contribute to the design principles of grief-related virtual reality experiences, bridging the gap between interactive media, mental health interventions, and immersive storytelling.

3369 – Gamified Augmented Reality for Enhancing Cognitive Function and Social Participation in Dementia Patients

Hanchun Huang and Hsiao Wen Chuang

[Download Paper]

Keywords: Dementia, Serious Game, Augmented Reality, Nutrition Education, Cognitive Training, Elderly Care, Social Participation

Abstract:

This study introduces the “AR Magic Plate game”, a WebAR-based, gamified augmented reality system designed to support cognitive function and social participation among elders with dementia. Integrating interactive food‐ group identification tasks with reflexive sensory cues rather than didactic nutrition instruction, the platform delivers automatic prompts and rewards to reinforce healthy eating responses. Users engage by scanning AR markers on food cards and selecting the missing category from six major food groups; correct selections earn points that contribute to personalized rankings. A pilot deployment with 12 participants aged 71–103 years demonstrated that the system’s intuitive interface and gamified incentives successfully motivated engagement across the entire age span, with most users achieving high scores (4–5 out of 5). Statistical analysis confirmed no significant association between age and performance, underscoring the intervention’s capacity to evoke active participation irrespective of chronological age. These results suggest that the AR Magic Plate game offers a scalable, low-barrier, non-pharmacological approach for delivering cognitive stimulation and social interaction in dementia care.

3416 – FTS App: Towards Explainable AI-Driven Adaptive Weight Tracking

Grace Ataguba, Oladapo Oyebode, Dharven Yatinkumar Doshi and Rita Orji

[Download Paper]

Keywords: AI, weight management, multi-model, physical activity, nutrition

Abstract:

We present the FTS app, an adaptive weight management tracking application that integrates an explainable artificial intelligence (XAI) model, specifically designed for normal weight individuals who aim to maintain their current weight status. Weight maintenance requires consistent monitoring of calories consumed from food and those expended through exercise, a challenging task with conventional apps available on Play Store or App Store. The FTS app uniquely analyzes both food logs and daily steps to predict users' current weight. A key feature is its explainable AI framework that helps users understand why certain foods might trigger weight fluctuations and offer healthier alternatives. The system integrates two complementary models: (1) a ChatGPT-4 model and (2) the proprietary FTS- XAI model, both designed to classify foods as healthy or unhealthy while calculating caloric content to estimate the user's current weight. The app includes a built-in step counting module that tracks physical activity before meals, eliminating the need for expensive wearable devices and reducing privacy concerns related to third- party access. By combining these calorie metrics, the app automatically calculates the user's current weight and keeps them informed. This paper presents our design framework to guide the research community in addressing the needs of this predominantly overlooked population with weight maintenance goals.

3693 – A Conceptual Framework for Designing Effective Serious Games for Learning

Zahara Abdulhussan Al-Awadai

[Download Paper]

Keywords: serious games, serious games functional requirements, game development, conceptual framework, game components.

Abstract:

Serious games have emerged as a valuable tool for enhancing learning across various fields, extending beyond entertainment to improve education and training outcomes. This research investigates the use of serious games as a tool for enhancing learning and identifies key requirements and aspects essential for improving their design process. We propose a conceptual framework that supports the development of impactful serious games, focusing on their educational and entertainment aspects. The framework includes three models—structure, behavioral dynamics, and user experience—that facilitate collaboration among multidisciplinary development teams and align game mechanics with learning objectives. It also provides a "dictionary" to help the development team adapt game mechanics to the game's educational goals. To validate the framework, we designed a serious game as a web application, redesigned an existing game, and compared our approach with existing frameworks. Results demonstrate that our framework offers more precise models for integrating the gaming and educational aspects, allows a detailed decomposition of game components, and provides clearer graphical and textual representations. This, in turn, simplifies the comparison of different games and provides deeper insights into game challenges and player engagement.

3896 – Girl’s Healing Travel: a Gamified Tool for Mental Resilience Cultivation Based on R²EM

Yudong Lin, Yuheng Yang, Xing Sun and Shiguang Ni

[Download Paper]

Keywords: Mental Resilience, R2EM, Gamified Tool

Abstract:

With the rapid advancement of society, mental health challenges have become a global concern, driven by factors such as social stress, personal trauma, and physiological influences. In response, fostering mental resilience—the ability to adapt effectively to adversity—has emerged as a critical strategy for mitigating the risk of mental disorders. This paper presents the development of a gamified tool designed for both assessing and cultivating mental resilience. Grounded in the Recovery and Resilience in Entertaining Media Use Model (R2EM), the tool transforms traditional resilience assessment questionnaires into a narrative-driven format, while integrating real-time visualization techniques to dynamically represent players’ psychological states. Experimental findings reveal significant improvements in play- ers’ mental resilience scores following gameplay, demonstrating the potential of gamification as an effective approach for mental resilience training.

5465 – CalmMe: An AI-Driven Adaptive and Personalized System for Stress Detection and Management

Aman Desai, Dharmil Shah, Oladapo Oyebode, Grace Ataguba and Rita Orji

[Download Paper]

Keywords: stress detection, stress management, artificial intelligence, machine learning, deep learning, heart rate variability, sensor technology, adaptivity, personalization, health, well-being, intervention design

Abstract:

Stress is a prevalent concern in modern society, affecting mental and physical health. Accurate and timely stress detection can enable individuals to take preventive actions, reducing its adverse effects. This work presents the CalmMe app, an AI-driven and mobile-based system that uses heart rate variability (HRV) data to predict stress levels using sensor technology and machine learning models, and then provide personalized and evidence-based interventions. HRV data, automatically collected via Apple Watch, is processed using statistical and time-domain features, with SDNN (standard deviation of Normal-to-Normal intervals) as the primary metric. The comparative evaluation of convolutional neural network (CNN), Support Vector Machine (SVM), and three other models (Random Forest, Logistic Regression, and LSTM) show that CNN is the best performing model overall with an accuracy and F1- score of 98.5% and 98%, respectively. The app visualizes stress trends, categorizes stress into chronic, mild, and low levels, and recommends personalized interventions to manage stress effectively. This research showcases the practicality of integrating wearables and artificial intelligence (AI) for stress monitoring and management by designing and developing the CalmMe app which holds promise as a personalized and adaptive system for promoting the physical and mental well-being of people globally.

6048 – SerenCoach: An AI-Driven Persuasive Digital Coach for Anxiety and Depression Management

Vishesh Dipal Patel, Oladapo Oyebode, Grace Ataguba and Rita Orji

[Download Paper]

Keywords: persuasive technology, digital coach, artificial intelligence, large language models, mental health, mobile application, health, well-being, personalization, intervention design.

Abstract:

Despite the prevalence of mental health issues such as anxiety and depression, access to timely and personalized care remains limited. SerenCoach is an AI-driven, persuasive, and mobile-based digital coach designed to support anxiety and depression management through multimodal analysis of facial expressions and voice. By leveraging advanced technologies, including Facial Expression Recognition (FER) model, Large Language Models (LLMs) such as Llama3, and persuasive strategies, SerenCoach assesses users’ anxiety and depression risk levels and provides personalized interventions. SerenCoach’s methodology involves engaging in a conversation/dialogue with users while analyzing facial expressions and verbal expression of personal experiences or health condition (which is automatically converted to text) to assess their risk level. Based on the assessed risk – categorized as low, medium, or high – the app delivers personalized and evidence-based interventions including guided meditation, gratitude journaling, AI-powered therapist, and access to emergency services. SerenCoach motivates users through goal setting, reminder, and progress tracking to enhance user engagement. This paper discusses the design and development of SerenCoach, and demonstrates its ability to improve mental well- being through interactive, adaptive, and real-time support.

7425 – A Serious Game to Measure Time Perception in Driving: Towards Context-Based Measurement

Yoones Sekhavat, Abbas Mousivand, Hesam Sakian, Leila Dobakhti and Joseph Mani

[Download Paper]

Keywords: Time Perception, Context-based Measurement, Driving Game.

Abstract:

The study of time perception, a field within psychol- ogy and cognitive science, has garnered significant interest from researchers. Time perception refers to the subjective experience of time, a fundamental aspect of human awareness that influences behavior. Traditionally, time perception is measured using a classic test where a symbol is displayed to a participant for a fixed duration, after which the participant attempts to replicate this duration by holding down the keyboard space bar for the same amount of time. We argue that time perception is not a general skill but should be assessed within specific contexts and scenarios. Given the importance of time perception in driving, this paper proposes a technique to measure time perception in driving scenarios. We utilize a car driving game to evaluate drivers’ time perception during overtaking scenarios. To validate our proposed system, we conducted a user study to determine the correlation between time perception in our system and the classic time perception test results. The findings revealed a significant correlation between the time perception metrics in our system and the classic test in both underestimation and overestimation conditions. These results indicate the viability of using the car driving game to measure time perception in driving scenarios and suggest its potential as an intervention tool to enhance time perception skills in driving contexts.

8060 – STEM Odyssey: A Chapter-Based Game for Stress Management in STEM Students

Gabriel J. Roberts, Sussan Anukem, Gerry Chan, Makuochi Nkwo and Rita Orji

[Download Paper]

Keywords: Behavior change, mobile health (mHealth), stress management, gamification, persuasive strategies, serious games

Abstract:

Mobile Health (mHealth) games are gaining popularity as they can help users better understand health information, including stress management and well-being. In this study, we report on the results of a mobile chapter-based serious game, STEM Odyssey, designed to engage users in stress-reducing activities through an interactive narrative and choice-based decision-making gameplay. The game simulates various academic and social stress scenarios common in university life and incorporates principles from the Persuasive Systems Design (PSD) model to motivate users and change behavior. Prior to the development of a fully functional and playable game, we sketched wireframes of the user interface, followed by an interactive prototype on Figma. We then conducted a usability test, as well as a questionnaire and semi-structured interviews with six target participants to gather qualitative and quantitative data about users' perceptions of the game and intuitiveness of the user interface. Our preliminary findings indicate that the user interface is usable, simple, and overall, the persuasive strategies applied in the design are effective at promoting behavior change. Based on these results, we plan to revise the prototype and conduct a second round of evaluation before proceeding with the full development and field evaluation of the game with a large sample.