Influence of Avatar Identification on the Attraction of Virtual Reality Games: Survey Study.

BACKGROUND: In gaming, the embodied interaction experience of avatars serves as a key to emotional sublimation in artistic creation. This presents the emotional expression of art in a more vivid form, which is a critical factor in the high attractiveness of virtual reality (VR) games to players. Intertwined with players' physiological and psychological responses, immersion is an essential element for enhancing gaming attractiveness. OBJECTIVE: This study aims to explore how to help players establish a sense of identity with their embodied avatars in VR game environments and enhance the attractiveness of games to players through the mediating effect of immersion. METHODS: We conducted a structured questionnaire survey refined through repeated validation. A total of 402 VR users were publicly recruited through the internet from March 22, 2024, to April 13, 2024. Statistical analysis was conducted using the SPSS and Amos tools, including correlation analysis, regression analysis, and mediation effect verification. We divided the self-differentiation theory into 4 dimensions to validate their impact on avatar identification. Subsequently, we correlated the effects of avatar identification, game immersion, and game attractiveness and proposed a hypothetical mediating model. RESULTS: Regression analysis of the predictor variables and the dependent variable indicated a significant positive predictive effect (P<.001); the variance inflation factor values for each independent variable were all <5. In the hypothesis testing of the mediating effect, the total mediating effect was significant (P<.001). Regarding the direct impact, both the effect of avatar identification on immersion and the effect of immersion on game attractiveness were significant (P<.001). However, the direct effect of avatar identification on game attractiveness was not significant (P=.28). Regarding the indirect impact, the effect of avatar identification on game attractiveness was significant (P<.001). The results indicate a significant positive correlation between different dimensions of the self-differentiation theory and identification with avatars. Moreover, immersion in the game fully mediated the relationship between identification with avatars and game attractiveness. CONCLUSIONS: This study underscores that the embodiment of avatar identification is influenced by dimensions of self-differentiation, and the impact of identification with avatars on game attractiveness is contingent upon full mediation by immersion. These findings deepen our understanding of the role of avatar identification in VR gaming.

Effects of video game immersion and task interference on cognitive performance: a study on immediate and delayed recall and recognition accuracy.

This study investigates the cognitive impacts of video game immersion and task interference on immediate and delayed recall as well as recognition tasks. We enrolled 160 subjects aged 18 to 29, who were regular players of "shoot-em-up" video games for at least 3 years. Participants were assigned to one of three experimental groups or a control group. The experimental conditions varied in the timing and type of tasks: the first group performed a video game session between recall tasks, the second group multitasked with video games and recall tasks simultaneously, and the third group engaged in task switching from video games to recall tasks. Using the Rey Auditory Verbal Learning Test, we measured the effects of these conditions on cognitive performance, focusing on error types and recall accuracy. Results indicated that multitasking and task switching significantly affected the subjects' performance, with notable decrements in recall and recognition accuracy in conditions of high task interference. The study highlights the cognitive costs associated with multitasking in immersive digital games and provides insights into how task similarity and interference might increase error rates and affect memory performance.

Detection and Characterization of Online Substance Use Discussions Among Gamers: Qualitative Retrospective Analysis of Reddit r/StopGaming Data.

BACKGROUND: Video games have rapidly become mainstream in recent decades, with over half of the US population involved in some form of digital gaming. However, concerns regarding the potential harms of excessive, disordered gaming have also risen. Internet gaming disorder (IGD) has been proposed as a tentative psychiatric disorder that requires further study by the American Psychological Association (APA) and is recognized as a behavioral addiction by the World Health Organization. Substance use among gamers has also become a concern, with caffeinated or energy drinks and prescription stimulants commonly used for performance enhancement. OBJECTIVE: This study aimed to identify substance use patterns and health-related concerns among gamers among a population of Reddit users. METHODS: We used the public streaming Reddit application programming interface to collect and analyze all posts from the popular subreddit, r/StopGaming. From this corpus of posts, we filtered the dataset for keywords associated with common substances that may be used to enhance gaming performance. We then applied an inductive coding approach to characterize substance use behaviors, gaming genres, and physical and mental health concerns. Potential disordered gaming behavior was also identified using the tentative IGD guidelines proposed by the APA. A chi-square test of independence was used to assess the association between gaming disorder and substance use characteristics, and multivariable logistic regression was used to analyze whether mental health discussion or the mention of any substance with sufficient sample size was significantly associated with IGD. RESULTS: In total, 10,551 posts were collected from Reddit from June 2017 to December 2022. After filtering the dataset for substance-related keywords, 1057 were included for further analysis, of which 286 mentioned both gaming and the use of ≥1 substances. Among the 286 posts that discussed both gaming and substance use, the most mentioned substances were alcohol (n=132), cannabis (n=104), and nicotine (n=48), while the most mentioned genres were role-playing games (n=120), shooters (n=90), and multiplayer online battle arenas (n=43). Self-reported behavior that aligned with the tentative guidelines for IGD was identified in 66.8% (191/286) posts. More than half, 62.9% (180/286) of the posts, discussed a health issue, with the majority (n=144) cited mental health concerns. Common mental health concerns discussed were depression and anxiety. There was a significant association between IGD and substance use (P<.001; chi-square test), and there were significantly increased odds of IGD among those who self-reported substance use (odds ratio 2.29, P<.001) and those who discussed mental health (odds ratio 1.64, P<.03). CONCLUSIONS: As gaming increasingly becomes highly prevalent among various age groups and demographics, a better understanding of the interplay and convergence among disordered gaming, substance use, and negative health impacts can inform the development of interventions to mitigate risks and promote healthier gaming habits.

Father-child attachment on children's screen time: mediating role of ego resilience.

BACKGROUND: Children spend a significant amount of time engaging in sedentary behaviors, defined as activities that do not increase energy expenditure significantly above resting levels, such as watching TV and playing PC/video games. Increased screen time is a significant public health concern because children are in a developmental stage where lifestyle behaviors predict various health outcomes in adulthood and beyond. This study explores the links between parent-child attachment, ego resilience, and children's screen time. METHODS: This cross-sectional correlation study uses 1,163 parents and their children data from the 12th Panel Survey of Korean Children. The study instruments were a modified Armsden and Greenberg scale of parent-child attachment and modified the children's ego resilience scale of the Block and Kremen. Children's screen time was classified as more than 2 h per day spent watching television, playing on computers, or playing video games in their leisure time. RESULTS: Study results show a negative association between father-child attachment and children's screen time (ß = -0.43, p < .001) and a positive association between father-child attachment and ego resilience (ß = 0.24, p < .001). Ego resilience showed a negative link to children's screen time after adjusting for parental attachment (ß =- 0.03, p = .009). Father-child attachment link to children's screen time (ß = -0.36, p < .001) continued even though the association was slightly reduced in magnitude after adjusting for ego resilience. CONCLUSIONS: Our findings show the mediating role of ego resilience on a negative path of father-child attachment to children's screen time. This finding emphasizes the importance of fostering solid father-child relationships and enhancing children's psychological resilience as critical strategies for reducing excessive screen time. By addressing emotional support and resilience-building, interventions can more effectively promote healthier behavioral outcomes in children.

Role models in gaming: Wishful identification and maladaptive daydreaming mediate the association between desire for fame and game engagement.

BACKGROUND: The popularity of video games has considerably increased in recent years, with approximately 3.24 billion players worldwide in 2021. Empirical evidence suggests that the quality of engagement in video games can determine whether a gaming activity is associated with psychological distress (i.e., problematic gaming) or self-enhancing outcomes (i.e., esports career pursuits). This study investigates the role of influential gaming role models and other external factors relating to fame appeal in gamers' different ways of engagement. METHODS: A total of 803 adolescent and adult gamers (89.29 % male, Mage = 24.90 years, SD = 6.13) were recruited through an online questionnaire. RESULTS: A path analysis was constructed demonstrating that wishful identification partially mediated the relationship between desire for fame and esports career planning. Moreover, maladaptive daydreaming fully mediated the association between desire for fame and gaming disorder symptoms. Wishful identification with gaming role models predicted both esports career planning and gaming disorder symptoms. CONCLUSIONS: The findings shed light on the importance of considering the role of gaming role models in predicting healthy and problematic gaming patterns.

The mediating effect of social connectedness between internet gaming disorder and somatic symptoms in adolescents: a large sample cross-sectional study.

BACKGROUND: Previous studies have indicated that social connectedness can serve as a protective buffer against negative outcomes associated with online victimization. However, the role of social connectedness between Internet gaming disorder and somatic symptoms is still unclear. This study aims to examine the mediating effect of social connectedness on the association between Internet gaming disorder and somatic symptoms. METHODS: A cross-sectional design was utilized, using questionnaires for data collection and multi-stage stratified cluster sampling. The general demographic questionnaire, Nine-Item Internet Gaming Disorder Scale-Short Form, Social Connectedness Scale-Revised and Patient Health Questionnaire Physical Symptoms were used to collect data. We adopted Pearson's correlation analysis and the PROCESS Macro Model in regression analysis to explore the relationships among Internet gaming disorder, social connectedness and somatic symptoms. RESULTS: Internet gaming disorder was positively correlated with somatic symptoms (r = 0.20, P < 0.001), while network (r=-0.08, P < 0.001) and real-life social connectedness (r=-0.31, P < 0.001) negatively affected somatic symptoms. The network social connectedness and the real-life social connectedness played a chain mediating role in the development of Internet gaming disorder to somatic symptoms [95%CI: 0.073, 0.088], explaining 45.25% of the total effect value. The difference of real-life social connectedness and network social connectedness played a partial mediating role between Internet gaming disorder and somatic symptoms [95% CI:0.050, 0.062], accounting for 31.28% of the total effect value. CONCLUSIONS: Real-life social connectedness, network social connectedness, and their disparity all mediated the relationship between Internet gaming disorder and somatic symptoms. Real-life social connectedness acted as a protective factor, while network social connectedness served as a risk factor. Encouraging offline activities and guiding teenagers to use the internet responsibly may help prevent and reduce physical symptoms linked to Internet gaming disorder.

Factor analysis of impulsivity in gaming disorder and internet gaming disorder.

BACKGROUND: Research suggests that a two-factor model of impulsivity predicts Substance Use Disorder and Gambling Disorder. We aimed to determine whether a similar factor structure was present for Gaming Disorder (GD) and Internet Gaming Disorder (IGD). METHODS: Secondary data analysis was conducted on survey responses from 372 participants who had completed a series of questions on facets of impulsivity and their involvement in gaming. Participants were sampled from gaming forums and an online recruitment website. Exploratory factor analysis was conducted on the measures of trait impulsivity, and the identified factors were then analyzed against measures of Gaming Disorder and Internet Gaming Disorder. A confirmatory factor analysis was then run to confirm the model. RESULTS: The exploratory results suggested a five-factor model of impulsivity, with gaming being related to all five factors. Interestingly, only two of those factors (Urgency (Positive Urgency, Negative Urgency, Delay Discounting) and (Impaired) Inhibitory Control (False Button Presses on Go/No-Go Tasks)) predicted symptom counts above the clinical cut-off for IGD. In addition, Urgency was related to symptom counts above 7/9 criteria for IGD, as well as symptom counts above the suggested clinical cut-off for GD. The confirmatory factor analysis suggested that this two-factor model of impulsivity had 'good fit.' CONCLUSIONS: This two-factor model of impulsivity is similar to those found in established addiction disorders, in that one factor appears to predict more problematic involvement than the other. However, the results indicate that Urgency predicts higher symptom counts than (Impaired) Inhibitory Control. This contrasts with previous findings on substance use and gambling, where (Impaired) Inhibitory Control was the factor predicting problematic use. However, there was evidence to suggest that gaming is similar to alcohol consumption, where socially acceptable, "healthy," use is related to impulsivity at some level, but Urgency is key in the transition from recreational to disordered behavior.

Hikikomori in the Middle East: The role of problematic gaming, social media use, and loneliness.

Hikikomori, a form of severe social withdrawal has been found to be associated with behavioral addictions such as gaming addiction and problematic social media use (PSMU). Since literature related to hikikomori is lacking in the Middle East, this study aimed to determine whether there are significant differences in hikikomori-like traits between two different types of social media users and gamers and investigate loneliness as a potential mediator between hikikomori and the two types of problematic behaviors. A cross-sectional, correlational design was employed, collecting a final sample of 220 participants residing in Middle Eastern countries using a mixture of convenience and snowball sampling. Results showed that passive social media users demonstrated significantly greater hikikomori-like traits compared to active users. Furthermore, hikikomori-like traits exhibited significant positive associations with problematic gaming, PSMU, and loneliness. Two separate mediation analyses, the first with PSMU and a second with problematic gaming as predictors, revealed that loneliness acted as a significant mediator between both these problematic behaviors and hikikomori-like traits.

Transfer from goal-directed behavior to stimulus-response habits and its modulation by acute stress in individuals with risky gaming behavior.

Habitual responses towards addiction-related cues play a relevant role in the development and maintenance of addictions. Such automatic responses may be more likely under stress, as stress has been shown to induce a shift from goal-directed to habitual behavior. The current study investigated these mechanisms in risky gaming behavior. Individuals with risky gaming behavior (n = 68), as established by a structured clinical interview, and a matched control group (n = 67) completed a Pavlovian-to-Instrumental Transfer (PIT) paradigm with gaming-related cues and rewards. After the Pavlovian training, participants underwent a stress (Trier Social Stress Test) or control condition before performing the instrumental training and the transfer phase of the PIT paradigm. To assess habitual behavior, the gaming-related rewards were devalued after half of the transfer phase. In both groups, gaming-related cues enhanced the choice of the gaming-related reward and this gaming PIT effect was reduced, however, not eliminated by the devaluation. Unexpectedly, stress did not significantly increase responding for the gaming-related reward in participants aware of the stimulus-outcome associations, however seemed to enhance habitual responding in unaware participants. Our findings underline the relevance of gaming-related cues in triggering habitual responses, which may undermine attempts to change a problematic gaming behavior.

The ninth art, tells the story of cultural China and the world: Cultural interaction in cross-cultural video game communication-based on 'Genshin Impact' YouTube comments.

China has attached increasing importance to the overseas dissemination of traditional culture as it continues to strengthen its comprehensive national strength and develop globalization initiatives. The electronic game, as the 'ninth art', with its booming development and inherent cross-cultural communication platform attributes, has taken on the important task of taking culture abroad. This study selects 'Genshin Impact', a game highly praised and well-received globally, which contains an abundance of Chinese cultural elements and cultural elements from various regions of the world, to study cultural interaction in cross-cultural communication of electronic games. This study conducts text sentiment analysis and semantic network analysis on the comments of 'Genshin Impact' videos on the overseas video platform YouTube and studies the cultural interaction in the cross-cultural communication of the 'ninth art', telling the cultural stories of China and the world from a multicultural perspective. The study found that games and derivative videos triggered positive emotional responses from audiences both at home and abroad. While experiencing pleasure and surprise, audiences also arouse deeper emotions such as admiration, identification, and expectation. Meanwhile, in the complex art form of the 'ninth art', audiences can absorb the cultural elements of different cultures, resonate with the elements of their cultural circle, and even trigger further profound thinking. Finally, this study provides constructive suggestions on using the 'ninth art' to better 'tell China's stories and disseminate China's voice'.

The effect of digital game addiction on aggression and anger levels in adolescents: A cross-sectional study.

PURPOSE: In this study, it was aimed to determine the effect of digital game addiction on aggression and anger levels in adolescents. DESIGN AND METHODS: The participants of this cross-sectional study were adolescents. Data were collected using a socio-demographic questionnaire, Game Addiction Scale, and Buss-Perry Aggression Scale. Descriptive statistics, t-test, Anova, correlation and linear regression analysis were used in the analysis of the data. RESULTS: In this study, game addiction and aggression levels of adolescents were determined as moderate. The game type that adolescents played the most was determined as war games with 35 %. The mean score of the Game Addiction Scale for male adolescents, those with medium and high income levels, those who play digital games for >8 h a day and every day, was found to be significantly higher. In this study, a positive and moderately significant correlation was found between Game Addiction Scale and Aggression Total Scale and Anger subscale (p < 0.05). Especially male gender (ß = 0.273), high income status (ß = -0.089), long time playing digital games (ß = 0.173) and playing digital games every day (ß = 0.360) were determined as predictors that increase game addiction. CONCLUSIONS: Digital game addiction can trigger aggression and anger in adolescents. Nurses play a crucial role in screening and identifying adolescents at risk of game addiction to prevent aggression and anger. PRACTICE IMPLICATIONS: According to the findings of this research, it is necessary to provide training and counseling to prevent digital game addiction in schools and to plan strategies by psychiatric nurses.

Relationship between awareness of digital game addiction, health literacy, and sociodemographic characteristics of mothers: A structural equation modeling analysis.

AIM: Mothers' digital game addiction awareness and their health literacy levels are critical factors for addiction prevention strategies in children. Therefore, the present study is significant. This study examines the relationship between awareness of digital game addiction, health literacy, and the sociodemographic characteristics of mothers. METHOD: This cross-sectional study was conducted with 457 mothers of children aged 5-11 years in Turkey. The data were collected using a personal information questionnaire, the Awareness of Digital Game Addiction Scale, and the Health Literacy Scale between May and September 2021. RESULTS: This study revealed that mothers are highly aware of digital game addiction and have high health literacy. Furthermore, health literacy was determined to significantly and directly affect awareness of digital gaming addiction. Awareness of digital gaming addiction significantly and directly affects children owning their own technological devices and how much time mothers spend with their children. CONCLUSION: The study's results confirmed that mothers' health literacy had a positive and statistically significant effect on awareness of digital gaming addiction. As the health literacy levels of mothers increased, the internal and external awareness of digital gaming addiction increased. It is recommended to design intervention programs that increase mothers' awareness of digital game addiction. These programs should be planned according to the health literacy levels of mothers.

COVID-19-Related Social Isolation, Self-Control, and Internet Gaming Disorder Among Chinese University Students: Cross-Sectional Survey.

BACKGROUND: Internet gaming disorder among university students has become a great concern for university counsellors worldwide since the COVID-19 pandemic. The factors influencing the development of internet gaming disorder in students during the COVID-19 pandemic could be different from those before the pandemic. OBJECTIVE: This study aims to explore the associations among social isolation, self-control, and internet gaming disorder in Chinese university students and to examine whether self-control mediates the positive effects of social isolation on internet gaming disorder. METHODS: A cross-sectional survey was employed to collect data from university students in Shandong province of China from April to September 2022. The Isolation subscale of the Self-Compassion Scale, Self-Control Scale, and Internet Gaming Disorder Scale were used to assess the social isolation, self-control, and internet gaming disorder among university students, respectively. Models 4 and 5 of PROCESS software were used to analyze the mediating role of self-control and the moderating role of gender on the association between social isolation and internet gaming disorder. RESULTS: A total of 479 students were recruited from 6 universities located in 3 different regions of Shandong, China. Students had low levels of internet gaming disorder and moderate levels of social isolation and self-control, with mean scores of 8.94 (SD 9.06), 12.04 (SD 3.53), and 57.15 (SD 8.44), respectively. Social isolation was positively correlated with internet gaming disorder (r=0.217; P<.001), and self-control was negatively correlated with social isolation (r=-0.355; P<.001) and internet gaming disorder (r=-0.260; P<.001). Self-control played a mediating role in the association between social isolation and internet gaming disorder (ß=-.185, 95% CI -.295 to -.087). The effects of social isolation on internet gaming disorder among female students were lower than those among male students. CONCLUSIONS: Self-control was a mediator in the association between social isolation and internet gaming disorder. Moreover, gender played a moderating role in the association between social isolation and internet gaming disorder. This study highlights the need to alleviate the development of internet gaming disorder among students during a pandemic, especially that of male students. Effective interventions that lessen social isolation and promote self-control should be developed.

Causal effect of video gaming on mental well-being in Japan 2020-2022.

The widespread use of video games has raised concerns about their potential negative impact on mental well-being. Nevertheless, the empirical evidence supporting this notion is largely based on correlational studies, warranting further investigation into the causal relationship. Here we identify the causal effect of video gaming on mental well-being in Japan (2020-2022) using game console lotteries as a natural experiment. Employing approaches designed for causal inference on survey data (n = 97,602), we found that game console ownership, along with increased game play, improved mental well-being. The console ownership reduced psychological distress and improved life satisfaction by 0.1-0.6 standard deviations. Furthermore, a causal forest machine learning algorithm revealed divergent impacts between different types of console, with one showing smaller benefits for adolescents and females while the other showed larger benefits for adolescents. These findings highlight the complex impact of digital media on mental well-being and the importance of considering differential screen time effects.

Rates and psychological stress predictors of problematic internet use (PIU) during the COVID-19 pandemic in a racially diverse sample of young adults.

BACKGROUND: Problematic internet use (PIU), which includes social media misuse (SMM) and gaming misuse (GM), is uncontrollable and associated with significant psychological impairment. PIU is a coping behavior for COVID-19-related stress. We explored distress-related predictors of PIU in a young adult racially diverse sample during the pandemic. METHODS: Analyses used cross-sectional survey data (N = 1956). Psychological diagnoses, financial distress, COVID-19-related emotions, psychological distress, distress tolerance, social support, loneliness, SMM and GM were measured. Hierarchical multiple regressions identified predictors of PIU. Race-stratified exploratory analyses sought to understand if predictors held true across racial groups. RESULTS: Low distress tolerance was associated with SMM and GM, as were depression symptoms, with racial differences observed. SMM was associated with younger age, and GM was associated with male gender. PTSD symptoms predicted more GM. SMM and GM rates varied between racial groups. COVID-19-related adjustment challenges and stress predicted SMM and GM respectively, with racial differences observed. CONCLUSION: Individual psychological distress and low distress tolerance markedly increased PIU risk. Clinicians should screen for stress-related PIU risk factors and bolster distress tolerance in vulnerable patients. Comparing PIU to different forms of coping in a larger sample would further clarify groups differences in stress coping behaviors.

Gamification for Mental Health and Health Psychology: Insights at the First Quarter Mark of the 21st Century.

The concept of gamification, originally rooted in digital media and game design, has increasingly emerged as a pivotal element in psychology and engagement strategies. Its application spans diverse domains within healthcare, offering innovative solutions to transform patient care through behavior modification and heightened engagement. This contemporary perspective explores theoretical frameworks and provides a critical interdisciplinary examination of current advancements in gamification for mental health and health psychology, identifying existing knowledge gaps and projecting future trends and research directions within these contexts. Based on this, concise criteria for designing, implementing, and evaluating gamification in healthcare, aligned with acknowledged best practices to promote ethical, fair, and trustworthy systems, are outlined, establishing a robust theoretical framework to design gamified interventions and scientifically evaluate their impact.

Digital Serious Games to Promote Behavior Change in Children With Chronic Diseases: Scoping Review and Development of a Self-Management Learning Framework.

BACKGROUND: Digital serious games (SGs) have rapidly become a promising strategy for entertainment-based health education; however, developing SGs for children with chronic diseases remains a challenge. OBJECTIVE: In this study, we attempted to provide an updated scope of understanding of the development and evaluation of SG educational tools and develop a framework for SG education development to promote self-management activities and behavior change in children with chronic diseases. METHODS: This study consists of a knowledge base and an analytical base. This study followed the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. To build the knowledge base, 5 stages of research were developed, including refining the review question (stage 1), searching for studies (stage 2), selecting relevant studies (stage 3), charting the information (stage 4), and collating the results (stage 5). Eligible studies that developed SG prototypes and evaluated SG education for children with chronic diseases were searched for in PubMed, Embase, Google Scholar, and peer-reviewed journals. In the analytical base, the context-mechanism-output approach and game taxonomy were used to analyze relevant behavioral theories and essential game elements. Game taxonomy included social features, presentation, narrative and identity, rewards and punishment, and manipulation and control. A total of 2 researchers selected the domains for the included behavioral theories and game elements. The intended SG framework was finalized by assembling SG fragments. Those SG fragments were appropriately reintegrated to visualize a new SG framework. RESULTS: This scoping review summarized data from 16 randomized controlled trials that evaluated SG education for children with chronic diseases and 14 studies on SG frameworks. It showed that self-determination theory was the most commonly used behavioral theory (9/30, 30%). Game elements included feedback, visual and audio designs, characters, narratives, rewards, challenges, competitions, goals, levels, rules, and tasks. In total, 3 phases of a digital SG framework are proposed in this review: requirements (phase 1), design and development (phase 2), and evaluation (phase 3). A total of 6 steps are described: exploring SG requirements (step 1), identifying target users (step 2), designing an SG prototype (step 3), building the SG prototype (step 4), evaluating the SG prototype (step 5), and marketing and monitoring the use of the SG prototype (step 6). Safety recommendations to use digital SG-based education for children in the post-COVID-19 era were also made. CONCLUSIONS: This review summarizes the fundamental behavioral theories and game elements of the available literature to establish a new theory-driven step-by-step framework. It can support game designers, clinicians, and educators in designing, developing, and evaluating digital, SG-based educational tools to increase self-management activities and promote behavior change in children with chronic diseases.

Health impact of screen addiction: A cross-sectional comparative study.

Background Prevalence-based, non-comparative studies have been done to assess psychological and physical consequences of social media and gaming addiction. However, similar studies are lacking for binge-watching, especially in India. We compared the physical and psychological health impact between screen addicted and healthy screen users, by minimizing bias due to confounding factors. Methods We did this cross-sectional comparative study among 120 participants (60 cases and 60 matched controls) consisting of gamers, social media users and binge-watchers, who were recruited from schools and colleges of Mumbai based on their scores on the Digital Addiction Scale (DAS). Levels of depression, anxiety and stress; sleep quality; and dry eye disease were assessed using pre-validated scales such as DASS-21, Pittsburgh Sleep Quality Index (PSQI), and Ocular Surface Disease Index (OSDI), respectively, while the other variables were assessed using a self-designed questionnaire with a content validity ratio (CVR) >0.65. Results The mean (SD) age of the participants was 19.3 (3.2) years, one-third were women; 68% were from medical colleges and 16% each from engineering colleges and high schools. The prevalence and scores of depression, anxiety and stress; poor sleep quality; and dry eye disease; and prevalence of loneliness, aggression and musculoskeletal pain in the wrist, thumb, neck and back were significantly higher in the screen addicted group (p<0.05). Conclusions There was a significant difference in the prevalence and levels of physical and psychological health impact between screen addicted and healthy screen users.

The Technology to Enhance Patient Motivation in Virtual Reality Rehabilitation: A Review.

Virtual reality (VR) technology has experienced a steady rise and has been widely applied in the field of rehabilitation. The integration of VR technology in rehabilitation has shown promising results in enhancing their motivation for treatment, thereby enabling patients to actively engage in rehab training. Despite the advancement, there is a dearth of comprehensive summary and analysis on the use of VR technology to enhance patient motivation in rehabilitation. Thus, this narrative review aims to evaluate the potential of VR technology in enhancing patient motivation during motor rehabilitation training. This review commences with an explanation of how enhancing motivation through the VR rehabilitation system could improve the efficiency and effectiveness of rehabilitation training. Then, the technology was analyzed to improve patient motivation in the present VR rehabilitation system in detail. Furthermore, these technologies are classified and summarized to provide a comprehensive overview of the state-of-the-art approaches for enhancing patient motivation in VR rehabilitation. Findings showed VR rehabilitation training utilizes game-like exercises to enhance the engagement and enjoyment of rehabilitation training. By immersing patients in a simulated environment with multisensory feedback, VR systems offer a unique approach to rehabilitation that can lead to improved patient motivation. Both ultimately lead to improved patient outcomes, which is not typically achievable with traditional rehabilitation methods. The review concludes that VR rehabilitation presents an opportunity to improve patient motivation and adherence to long-term rehabilitation training. However, to further enhance patient self-efficacy, VR rehabilitation should integrate psychology and incorporate methods. Moreover, it is necessary to build a game design theory for rehabilitation games, and the latest VR feedback technology should also be introduced.