Effect of a Mobile Game-Based Intervention to Enhance Child Safety: Randomized Controlled Trial.

BACKGROUND: Evidence supports the effectiveness of serious games in health education, but little is known about their effects on the psychosocial well-being of children in the general population. OBJECTIVE: This study aimed to investigate the potential of a mobile game-based safety education program in improving children's safety and psychosocial outcomes. METHODS: Safe City is a mobile roleplaying game specifically designed to educate children in Hong Kong about safety. This randomized controlled trial included 340 children in grades 4 through 6. Intervention arm participants (n=170) were instructed to play the Safe City mobile game for 4 weeks, whereas control arm participants (n=170) received a safety booklet. All participants completed a survey on safety knowledge and behaviors and psychosocial problems at baseline (T1), 1 month postintervention (T2), and 3 months postintervention (T3). Cumulative game scores and mini-game performance were analyzed as a proxy for the extent of exposure to the game. Outcome data were analyzed using 2-sample 2-tailed t tests to compare mean change from T1 to T2 and to T3 for intervention versus control arm participants. The association of game use with outcome changes postintervention was analyzed using generalized additive models. RESULTS: No significant differences were found in mean changes between the intervention and control arms. However, use analyses showed that higher game scores were associated with improvements in safe behavior (P=.03) and internalizing problems (P=.01) at T3. Matching and Spot the Danger mini-game performance significantly predicted improvements in safety knowledge at T2 and T3. CONCLUSIONS: Analysis of use has shown that playing the Safe City mobile game can result in significant improvements in safety knowledge and reductions in unsafe behavior and internalizing problems. These findings provide evidence for the positive impact of serious games on psychological and social well-being, highlighting the potential of technology-driven interventions to assist children in learning about safety and preventing injuries. TRIAL REGISTRATION: ClinicalTrials.org NCT04096196; https://clinicaltrials.gov/show/NCT04096196. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/17756.

The effect of mobile game training designed for asthmatic children on asthma management and quality of life.

PURPOSE: This study aimed to examine the effect of mobile game training designed for children with asthma on inhaler use skills, asthma symptoms and treatment needs, and quality of life. DESIGN AND METHODS: This randomized controlled study was conducted between April and October 2023 at "Pediatric Asthma and Allergy Clinic" in Turkey. The sample of the study consists of a total of 74 children diagnosed with asthma, including the Mobile game (n: 37) and the Control group (n: 37). In the study, a mobile game was developed for children with asthma between the ages of 8-12. In collecting research data; Child and Parent Information Form, Inhaler Use Skill Evaluation Form, Asthma Symptom and Treatment Need Scoring (Asthma Symptom Score [ASS], Rhinitis Symptom Score [RSS] and Total Symptom Score [TSS]), DISABKIDS Asthma Scale were used. RESULTS: There was no significant difference between the groups in terms of the demographic status of the children (p > 0.05). It was determined that the average inhaler use skill score and DISABKIDS asthma scale Child/Parent score average of the children in the mobile game group were higher than the control group (p < 0.05). When the children's final follow-up ASS, RSS and TSS total scores were examined; It was determined that there was a statistically significant difference between the children in the mobile game and control groups (p < 0.05). CONCLUSIONS: As a result of this study, it was determined that mobile game training designed for children is an effective method in increasing children's ability to use inhaler medications, reducing asthma symptoms and treatment needs, and improving quality of life. PRACTICE IMPLICATION: Nurses can improve children's quality of life by using mobile game training programs that attract children's attention.

Effectiveness of a dental simulation game on reducing pain and anxiety during primary molars pulpotomy compared with tell-show-do technique in pediatric patients: a randomized clinical trial.

BACKGROUND: Dental simulation games are virtual educational games that help children get familiar with different dental procedures. This study aimed to evaluate the pretreatment exposure to the "Baby Panda Dental Care" game in reducing pain and anxiety in comparison with the tell-show-do (TSD) technique during primary molars pulpotomy for patients aged 6-10 years. MATERIALS AND METHODS: It was a triple-blinded, two-arm, parallel-group, randomized, active-controlled trial. It was done on 60 patients, who were randomly divided into two groups: the control group, TSD technique (n = 30), and the experimental group, "Baby Panda Dental" Care (n = 30). For the TSD technique, children were provided with a verbal explanation followed by a demonstration of the dental treatment in a non-threatening way. The "do" phase is then initiated during performing treatment. For the "Baby Panda dental care" game, children were asked to play for 5 min before treatment, selecting root canal therapy procedures. Pulse rate and RMS pictorial scale were recorded at four time points: (1) at the baseline (t0). (2) After conditioning the child (t1). (3) During treatment (t2). (4) After finishing the treatment (t3). Face, Legs, Activity, Cry, Consolability (FLACC) behavioral pain scale was recorded during treatment (t2). RESULTS: The pulse rate is higher in the control group at t1 (p = 0.012) and t2 (p = 0.015). There was a statistically significant difference in the mean RMS pictorial scale score at t1 (p < 0.001), t2 (p = 0.006), and t3 (p < 0.001), a statistically significant difference was noticed in FLACC behavioral pain assessment between the two groups (p = 0.033). CONCLUSIONS: The mobile dental game showed better results than the TSD technique, but neither technique did not reduce anxiety and pain effectively during dental treatment. TRIAL REGISTRATION: The trial was registered at the ISRCTN registry (ISRCTN30470866) on 19/04/2024.

Study protocol for an individually randomized control trial for India's first roleplay-based mobile game for reproductive health for adolescent girls.

BACKGROUND: Go Nisha Go™ (GNG), is a mobile game combining behavioural science, human-centric design, game-based learning, and interactive storytelling. The model uses a direct-to-consumer (DTC) approach to deliver information, products, services, interactive learning, and agency-building experiences directly to girls. The game's five episodes focus on issues of menstrual health management, fertility awareness, consent, contraception, and negotiation for delay of marriage and career. The game's effectiveness on indicators linked to these issues will be measured using an encouragement design in a randomized controlled trial (RCT). METHODS: A two-arm RCT will be conducted in three cities in India: Patna, Jaipur, and Delhi-NCR. The first arm is the treatment (encouragement) arm (n = 975) where the participants will be encouraged to download and play the game, and the second arm (n = 975) where the participants will not receive any nudges/encouragement to play the game. They may or may not have access to the game. After the baseline recruitment, participants will be randomly assigned to these two arms across the three locations. Participants of the treatment/encouragement arm will receive continuous support as part of the encouragement design to adopt, install the game from the Google Play Store at no cost, and play all levels on their Android devices. The encouragement activity will continue for ten weeks, during which participants will receive creative messages via weekly phone calls and WhatsApp messages. We will conduct the follow-up survey with all the participants (n = 1950) from the baseline survey after ten weeks of exposure. We will conduct 60 in-depth qualitative interviews (20 at each location) with a sub-sample of the participants from the encouragement arm to augment the quantitative surveys. DISCUSSION: Following pre-testing of survey tools for feasibility of methodologies, we will recruit participants, randomize, collect baseline data, execute the encouragement design, and conduct the follow-up survey with eligible adolescents as written in the study protocol. Our study will add insights for the implementation of an encouragement design in RCTs with adolescent girls in the spectrum of game-based learning on sexual and reproductive health in India. Our study will provide evidence to support the outcome evaluation of the digital mobile game app, GNG. To our knowledge this is the first ever outcome evaluation study for a game-based application, and this study is expected to facilitate scalability of a direct-to-consumer approach to improve adolescent sexual and reproductive health outcomes in India. TRIAL REGISTRATION NUMBER: ctri.nic.in: CTRI/2023/03/050447.

Our paper describes implementation of a study protocol for an outcome evaluation of a mobile game app called Go Nisha Go™, produced by the Game of Choice, Not Chance™ project, funded by USAID. Consenting adolescent girls, aged 15­19, from three cities in India will be enrolled to participate in an encouragement design led RCT. Girls will be randomly assigned to either, a) a treatment (encouragement) arm where they will be nudged to play the game for ten weeks, or b) a control arm where participants will not be provided any encouragement to download or play the game. The study will be evaluated using surveys at baseline and follow-up. The findings from this study will support the measurement of effectiveness of the digital intervention and facilitate scalability of a direct-to-consumer approach, using a game-based application to improve adolescent sexual and reproductive health outcomes in India.

Mobile game-based learning as a solution in COVID-19 era: Modeling the pedagogical affordance and student interactions.

The closure of educational institutions due to the COVID-19 pandemic leads imperatively to the utilization of technological advances and the Internet for enabling the continuity of learning. To this direction, Mobile Game-based Learning (MGbL) can be beneficial to teaching and learning; since, from technological perspective, most students prefer to use their mobile devices, such as smartphones or tablets, and from pedagogical perspective, incorporating gaming in educational process can boost students' motivation for learning and improve their learning outcomes. Hence, this study investigates learners' intention to use MGbL as an alternative educational practice during the COVID-19 pandemic, by modeling the pedagogical affordance of this technology and student interactions with it. As a testbed for this research, a MGbL application was used for the instruction of the programming language C# in higher education, during the lockdown period of 2020. The findings reveal that the MGbL technology has a significant and positive impact on student engagement and academic performance.

How should theory guide a 'shift to digital' in mobile game-based learning?

This paper provides a theory-based critique and response to the Giannakas et al. [Educational Technology Research and Development, 66, 341-384 (2018). 10.1007/s11423-015-9396-3] critical review of mobile game-based learning. Within the framework of shifting-to-digital, the response discusses impact/value of the paper, possible application of the ideas found in the paper, limitations and constraints associated with the paper, and future suggestion for how the ideas in the paper should guide design and research.

Utilising mobile game based learning methods effectively to support education.

This paper is a response concerning the implications of scholarship of the article entitled "A critical review of 13 years of mobile game-based learning" by Giannakas et al. (in Educ Technol Res Dev 66:341-384, 2018). This response focuses on the key ideas presented in Giannakas et al. (2018) from a practical perspective, highlighting how practitioners, scholars and designers can use their findings to effectively utilise mobile Game Based Learning (mBGL) approaches to support and enhance learning. This response paper is discussing the value, impact and practical implications of Giannakas, et al. (2018) and possible future directions relevant to the use of smartphone enabled virtual reality to support mGBL.

Effect of implementing a mobile game on improving dietary information in diabetic patients.

Background: Nowadays, digital games are not just entertainment, but beside routine treatments, they are used in patient care, especially in patients with diabetes. Application of digital games in patient's education can improve self-management of diabetes. The aim of the present study was to evaluate the effect of a mobile game (Amoo) implementation on enhancing dietary information in patients with type 2 diabetes. Methods: A mobile game (called Amoo), which was developed by researchers of this study, was applied to assess the self-education of patients with diabetes. Sixty patients with type 2 diabetes participated in the study. The participants took part in a pre-intervention test to determine their dietary information. The participants were randomly divided into one of two groups, including the intervention group: played the game for 15 minutes daily for 6 weeks, and the control group: did not involve in the game. A post-intervention test was run to show a possible improvement in dietary information. Data were analyzed using paired t test and suitable non-parametric testes including Mann-Whitney and Wilcoxon signed rank tests as well as Spearman and Pearson correlation coefficients via IBM SPSS statistics version 21 (SPSS, v 21.0, IBM, Armonk, NY, USA). A P-value less than 0.05 was considered as a significant level. Results: The results indicated a statistically significant difference between the pre and post test scores in the intervention group (p<0.001). However, there was no significant difference in fasting blood sugar (p=0.125). Conclusion: The mobile game (Amoo) could enhance the knowledge of patients with type 2 diabetes about food calories and glycemic index. This means that mobile games may serve as an educational aid to these patients.

Relationship between the incidence of de Quervain's disease among teenagers and mobile gaming.

OBJECTIVE: To assess the relationship between the incidence of de Quervain's disease (DD) and mobile gaming. METHODS: We conducted an experimental cross-sectional study and surveyed specialized students with different majors from Xingtai Technician Institute. We applied the stratified clustered sampling method to recruit 500 students aged 16 to 20 years as survey respondents. We diagnosed DD by conducting Finkelstein's test. Chi-square test or Fisher's exact test was used to determine the correlation between different variables and Finkelstein's test results. SPSS 20 statistical software was used to perform all the statistical analyses. RESULTS: Among the five hundred students providing the valid data, there were 302 males and 198 females, with a male-to-female ratio of 3:2. Of them, 216, 159, 77, and 48 reported they played mobile games for < two, two to four, four to six, and > six hours per day, respectively. A total of 246 students (49%) had a positive result in Finkelstein's test. Three hundred and five (61.0%) students played mobile games with their wrist in dorsiflexion position, and among them, 192 had a positive result in Finkelstein's test. The statistical analyses showed that more frequent play, prolonged mobile gaming time per day, and changes in wrist position were significantly correlated with the positive rate of Finkelstein's test (p < 0.05). DISCUSSION: Our results show that the incidence of DD in students in the school was 49.0%. More frequent play, prolonged duration of mobile gaming, and change in wrist position were associated with higher risk of DD. We advocate the restricted time to less than 2.25 hours per day and the frequency in mobile gaming to prevent or reduce DD.

Education in Laparoscopic Cholecystectomy: Design and Feasibility Study of the LapBot Safe Chole Mobile Game.

BACKGROUND:  Major bile duct injuries during laparoscopic cholecystectomy (LC), often stemming from errors in surgical judgment and visual misperception of critical anatomy, significantly impact morbidity, mortality, disability, and health care costs. OBJECTIVE:  To enhance safe LC learning, we developed an educational mobile game, LapBot Safe Chole, which uses an artificial intelligence (AI) model to provide real-time coaching and feedback, improving intraoperative decision-making. METHODS:  LapBot Safe Chole offers a free, accessible simulated learning experience with real-time AI feedback. Players engage with intraoperative LC scenarios (short video clips) and identify ideal dissection zones. After the response, users receive an accuracy score from a validated AI algorithm. The game consists of 5 levels of increasing difficulty based on the Parkland grading scale for cholecystitis. RESULTS:  Beta testing (n=29) showed score improvements with each round, with attendings and senior trainees achieving top scores faster than junior residents. Learning curves and progression distinguished candidates, with a significant association between user level and scores (P=.003). Players found LapBot enjoyable and educational. CONCLUSIONS:  LapBot Safe Chole effectively integrates safe LC principles into a fun, accessible, and educational game using AI-generated feedback. Initial beta testing supports the validity of the assessment scores and suggests high adoption and engagement potential among surgical trainees.

Age and sex effects on Super G performance are consistent across internet devices.

There have been recent advances in the application of online games that assess motor skill acquisition/learning and its relationship to age and biological sex, both of which are associated with dementia risk. While this online motor learning assessment (called Super G), along with other computer-based cognitive tests, was originally developed to be completed on a computer, many people (including older adults) have been shown to access the internet through a mobile device. Thus, to improve the generalizability of our online motor skill learning game, it must not only be compatible with mobile devices but also yield replicable effects of various participant characteristics on performance relative to the computer-based version. It is unknown if age and sex differentially affect game performance as a function of device type (keyboard versus touchscreen control). Thus, the purpose of this study was to investigate if device type modifies the established effects of age and sex on performance. Although there was a main effect of device on performance, this effect did not alter the overall relationship between performance vs. age or sex. This establishes that Super G can now effectively be extended to both computer and mobile platforms to further test for dementia risk factors.

Online gaming and its effect on academic performance of Bangladeshi university students: A cross-sectional study.

Background and Aims: Due to the availability of more sophisticated cell phones with top-notch gaming functions, the present generation is more active. The available literature indicates that adolescents experience a variety of psychological issues, like low self-control brought on by an addiction to mobile games. Because of this, the aim of this study is to control the prevalence of, and factors that contribute to, online gaming addiction and its effects on academic performance in Bangladeshi university students. Methods: Convenient sampling was adopted to collect primary data from 399 Bangladeshi university students utilizing a prestructured questionnaire. Descriptive statistics, the χ 2 test, binary logistic regression, and multinomial logistic regression were also used to accomplish the study's objective. Results: According to this study, 62.7% of students play online games over 30 h every week. The findings also show that male students are more inclined than female students to show signs of addiction. Also, regular online gaming can result in long-term problems, and that factor including age, internet access, educational background, and frequency of play can influence the likelihood of these problems. The findings shows that a lower cumulative grade point average (CGPA), less physical activity, and less study time are associated with playing online games for at least 30 h per week. Moreover, the study found that playing online games, playing for long time, and skipping class can all have an adverse effect on a student's academic performance. Conclusions: The authors recommend that the authorities set up a good entertainment environment and take into account the findings of this article to discourage students from playing online games. Furthermore, encouragement of extracurricular activities such as sports or other pursuits is also essential in assisting Bangladeshi students in overcoming their addiction to mobile games.

The Mediating Effect of Psychological Ownership on the Relationship between Value Co-Creation and the In-App Purchasing Intention of Mobile Games Players.

In previous research on in-app purchasing, one of the revenue sources for mobile games focuses on users' unilateral relationships, such as their achievement, loyalty, and perception. However, little has been discussed about the commercial impact of the bilateral relationship. We extend discussions by examining an unprecedented issue, that is, the role of the bilateral relationships between users and mobile game companies in increasing in-app purchasing intention. We borrow from the business literature and psychology to hypothesize that when mobile game users co-create value with a mobile game company, their psychological ownership of the mobile game increases, which in turn increases their in-app purchasing intentions. To test this hypothesis, we conducted a carefully designed study by recruiting eighty-six Chinese game users. Half of the participants were exposed to an imaginary mobile game whose interface allowed them to co-create value with the mobile game company and the other half were exposed to an identical mobile game whose interface did not. We recruited participants from the two online platforms in which Chinese mobile game players gather-Weibo and WeChat Moment. Using SPSS 26, we conducted an independent samples test to test the effect of value co-creation and employed Hayes Model 4 to test whether psychological ownership mediated the relationship between value co-creation and in-app purchasing intention. We found that (1) when participants were allowed to co-create value, their in-app purchasing intentions increased, and (2) the relationship between value co-creation and in-app purchasing intention was mediated by psychological ownership. Our findings provide fresh insights for mobile game designers and marketers.

A Protocol for the Development and Assessment of a Non-Pharmacological Intervention Designed to Improve Cognitive Skills of Adults with Intellectual Disabilities: A Mixed Method Design.

Aim: This paper describes the steps of a protocol for developing and assessing a non-pharmacological intervention, specifically a Serious Game, with the goal of improving eight cognitive skills in adults with Intellectual Disabilities. Serious games that focus on one deficit and/or are restricted to one disorder have been developed to improve the cognitive skills of people with Intellectual Disabilities. There is a lack of a single tool that targets various cognitive skills as well as a broader spectrum of disorders. Purpose: The presentation of the protocol which describes the steps of developing a new Serious Game that will be evaluated in a randomised control trial intervention. Participants and Methods: The protocol is divided into three stages: identification of cognitive deficits and development of the Serious Game, randomised control trial intervention- follow up assessment, and evaluation of the Serious Game by trainers and caregivers. The participants of the intervention are adults with Intellectual Disabilities. Results: The protocol's results are expected to cover the development of a new Serious Game for specific cognitive functions of a mixed group of adults with Intellectual Disabilities, evaluating the structure and content of the game through neuropsychological assessments for participants and specific questionnaires for trainers and caregivers, evaluating the improvement of specific cognitive abilities in participants in the intervention; and measuring the possible improvement of the quality of life and social interaction of people with Intellectual Disabilities. Conclusion: This is the first study to develop a protocol and implement and assess this new Serious Game. This Serious Game is expected to assist people with Intellectual Disabilities in cognitive and social aspects.

A Design-Led Theory of Change for a Mobile Game App (Go Nisha Go) for Adolescent Girls in India: Multimix Methodology Study.

BACKGROUND: India has one of the largest adolescent populations in the world. Yet adolescents, particularly adolescent girls, have limited access to correct sexual and reproductive health information and services. The context in which adolescent girls live is one of gender inequity where they contend with early marriage and early pregnancy and have few opportunities for quality education and labor force participation. The digital revolution has expanded the penetration of mobile phones across India, increasingly being used by adolescent girls. Health interventions are also moving onto digital platforms. Evidence has shown that applications of game elements and game-based learning can be powerful tools in behavior change and health interventions. This provides a unique opportunity, particularly for the private sector, to reach and empower adolescent girls directly with information, products, and services in a private and fun manner. OBJECTIVE: The objective of this paper is to describe how a design-led Theory of Change (ToC) was formulated for a mobile game app that is not only underpinned by theories of various behavior change models but also identifies variables and triggers for in-game behavioral intentions that can be tracked and measured within the game and validated through a rigorous post-gameplay outcome evaluation. METHODS: We describe the use of a multimix methodology to formulate a ToC informing behavioral frameworks and co-design approaches in our proof-of-concept product development journey. This process created a statement of hypothesis and "pathways to impact" with a continuous, cumulative, and iterative design process that included key stakeholders in the production of a smartphone app. With theoretical underpinnings of social behavior and modeling frameworks, systematic research, and other creative methods, we developed a design-led ToC pathway that can delineate complex and multidisciplinary outputs for measuring impact. RESULTS: The statement of hypothesis that emerged posits that "If girls virtually experience the outcomes of choices that they make for their avatar in the mobile game, then they can make informed decisions that direct the course of their own life." Four learning pathways (DISCOVER, PLAY, DECIDE, and ACT) are scaffolded on 3 pillars of evidence, engagement, and evaluation to support the ToC-led framework. It informs decision-making and life outcomes through game-based objectives and in-game triggers that offer direct access to information, products, and services. CONCLUSIONS: This approach of using a multimix methodology for identifying varied and multidisciplinary pathways to change is of particular interest to measuring the impact of innovations, especially digital products, that do not necessarily conform with traditional behavioral change models or standard co-design approaches. We also explain the benefits of using iterative and cumulative inputs to integrate ongoing user feedback, while identifying pathways to various impacts, and not limiting it to only the design and development phase.

The Impact of a Gamified Mobile Mental Health App (eQuoo) on Resilience and Mental Health in a Student Population: Large-Scale Randomized Controlled Trial.

BACKGROUND: With many digital mental health interventions failing to engage clients for enough time to demonstrate substantive changes to their well-being and with only 2% of all digital solutions on app stores having undergone randomized controlled trials, the rising demand for mental health prevention and early intervention care is not being met. Young adults in particular struggle to find digital well-being apps that suit their needs. OBJECTIVE: This study explored the effects of eQuoo, an evidence-based mental health game that teaches psychological skills through gamification, on resilience, depression, anxiety, and attrition in a student population. METHODS: In total, 1165 students from 180 universities in the United Kingdom participated in a 5-week, 3-armed randomized controlled trial. Participants were randomly allocated into 1 of 3 groups: eQuoo users, users of a treatment-as-usual evidence-based cognitive behavioral health app called Sanvello, and a no-intervention waitlist. The Rugged Resilience Scale, Generalized Anxiety Disorder-7, and Patient Health Questionnaire-8 were administered to all participants at baseline and every 7 days until completion. RESULTS: A repeated measures-ANOVA revealed statistically significant increases in resilience scores in the test group (P<.001) compared with both control groups (Sanvello: P=.10 and waitlist: P=.82) over 5 weeks. The app also significantly decreased anxiety and depression scores (both P<.001). With 64.5% (251/389) adherence, the eQuoo group retained 42% more participants than the control groups. CONCLUSIONS: Digital health interventions such as eQuoo are effective, scalable, and low-cost solutions for supporting young adults and are available on all leading mobile platforms. Further investigation could clarify the extent to which specific elements of the eQuoo app (including gamification) led to better outcomes. TRIAL REGISTRATION: German Clinical Trials Register (DRKS) DRKS00027638; https://drks.de/search/en/trial/DRKS00027638.

MeetDurian: Can Location-Based Games be Used to Improve COVID-19 Hygiene Habits?

The COVID-19 problem has not gone away with the passing of the seasons. Although most countries have achieved remarkable results in fighting against epidemic diseases and controlling viruses, the general public is still far from understanding the new crown virus and lack imagination on its transmission law. Location-based games (LBGs) have been challenged during the on-going pandemic. No research has shown that LBGs can be used to help prevent COVID-19 infection. Therefore, we designed the game MeetDurian, which integrates entertainment, sports, and education. For investigating factors influencing intention to play the MeetDurian, we proposed some comparative evaluation. Data were gathered from participants who participated in capturing virtual durians and completed questionnaires about immersion into the game, workload assessment, user's emotions, learning outcomes, and personal hygiene. These results proved the acceptability and usability of the mobile game-based MeetDurian for preventing the infection and severity of the COVID-19 pandemic.

Examining Crisis Communication Using Semantic Network and Sentiment Analysis: A Case Study on NetEase Games.

The mobile game "Immortal Conquest," created by NetEase Games, caused a dramatic user dissatisfaction event after an introduction of a sudden and uninvited "pay-to-win" update. As a result, many players filed grievances against NetEase in a court. The official game website issued three apologies, with mix results, to mitigate the crisis. The goal of the present study is to understand user feedback content from the perspective of Situational Crisis Communication Theory through semantic network analysis and sentiment analysis to explore how an enterprise's crisis communication strategy affects users' attitudes. First, our results demonstrate that the diminishing crisis communication strategies (excuse and justification) do not change players' negative attitudes. It was not a failure because it successfully alleviated the players' legal complaints and refocused their attention on the game itself. Second, the rebuild (apology & compensation) strategy was effective because it significantly increased the percentage of positive emotions and regenerated expectations for the game. The litigation crisis was identified within gamer communications with respect to Chinese gaming companies for the first time. Nevertheless, this does not indicate an increase in overall legal awareness among the larger Chinese population. It may only reflect greater legal awareness among Chinese online gamers. Fourth, gamers emphasized that they and enterprises should be equally involved when communicating with each other. Finally, in-game paid items should be reasonably priced, otherwise, they will drive users to competitors.

Impact of Mobile Game Addiction Tendency on Chinese University Students: A Hierarchical Linear Modeling Study.

This study used hierarchical linear modeling (HLM) to investigate the differences in mobile game addiction tendencies among universities (i.e., double first-class universities, ordinary colleges and universities, and higher vocational colleges), and to examine the influencing factors of mobile game addiction tendency at the individual and university levels. The participants of this study were 4,024 college students who completed the Chinese Mobile Phone Game Addiction Scale, UCLA Loneliness Scale, and Positive and Negative Affect Scale. Loneliness (ß = 0.052), positive emotions (ß = -0.126), negative emotions (ß = 0.232), and double first-class universities (γ = 0.368) significantly predicted mobile game addiction tendencies. A significant cross-level interaction between double first-class universities and other factors (i.e., positive emotions, negative emotions, and mobile game addiction) was observed. The novelty of this study is that it distinguishes the various effects of mobile phone addiction tendency at the individual and university levels.

Spine Posture, Mobility, and Stability of Top Mobile Esports Athletes: A Case Series.

Professional esports athletes spend a long time in the same sitting posture during training and competition. Mobile esports may exacerbate potential postural problems because of the closer and unsupported arms and because athletes spend more time in a forward-/flexed-head posture. Prolonged sitting in these postures carries significant health risks and may lead to musculoskeletal problems and injuries. The objective of this retrospective study is to assess the posture, mobility, and stability of the spine for professional mobile esports athletes. We collected spine-assessment data from 48 athletes participating in a top-tier league on a real-time-strategy battle-arena online game. The spinal assessment was conducted using the SpinalMouse® under upright standing and trunk flexion in addition to the Matthiass test. Measurements were converted into Idiag Scores by the SpinalMouse® software. The Idiag Posture, Idiag Mobility, and Idiag Stability scores were 62.50 (IQR: 21), 63.50 (IQR: 19.5), and 54.50 (IQR: 14.5), respectively, and were significantly lower (p < 0.001) than the reference normative value (100). Age was found to have a weak positive correlation with the posture score (ρ = 0.29, p = 0.048). Although career duration appeared to lower the scores, the association was insignificant (p > 0.05). The scores also had no significant association with body height, body mass, body mass index, and esports team (p > 0.05). It was anticipated that mobile-based esports would attenuate the biomechanics of the spine and increase the likelihood of musculoskeletal problems, such as neck and back pain.