Debra Lieberman has served on the advisory board for Games for Health for the past two years. Her extensive expertise in this area has been invaluable in shaping this emerging field.

A rule-based activity involving challenge to reach a goal

In my reading and thinking about the definition of “game,” I have identified two basic elements that are the necessary conditions for an activity to be called a game: rules and a goal. As a result, my most basic definition is, “a rule-based activity involving challenge to reach a goal.” As soon as a goal is involved and the activity is bounded by rules, it becomes a game.

The challenge posed by a game could involve creativity, knowledge, conflict, competition, cooperation, social skills, persuasive skills, visual or aural acuity, eye-hand coordination, memory, multi-tasking, logic, or solving a mystery or puzzle. This list is a small sample of the kinds of challenges a game could provide, and as our technologies develop there will be even more.

Most of us have strong motivation to achieve and win in a game. Games test and develop our skills, stretch our capabilities, allow us to show off our talents, and can be tremendously engaging and fun.

Game features and game types

The following discussion focuses on games that are delivered by interactive media or are in some way supported by media and technology. It is not a comprehensive overview of the field, but instead it provides a few examples of games and their technologies, to show how widely applicable the definition of “game” can be.

Games usually provide performance feedback and the ability to monitor one’s progress toward reaching the game’s goal. User control is often a feature of games so that players can choose options, select game elements, and set the difficulty level.

An individual can play a game to reach a goal; a group can work together in a game to reach a goal; or opposing individuals or teams can compete in a game (or sport) with the goal being to win the competition.

A simulation is a model of a system or environment – with interrelated, interdependent elements – which responds system-wide to any change made within it. A simulation becomes a game when the user is given a goal to achieve at least one specific outcome within the simulated system.

A virtual world, such as Second Life, is an online environment in which participants can create characters, places, and events. The world is constructed by the participants, who interact with each other, develop friendships, share media and entertainment, buy and sell things, hold discussions and support group meetings, and find information. Games can take place in virtual worlds.

Mobile games are playable on a handheld device such as a PDA or cell phone. As mobile phones become increasingly multi-purpose, multi-media, networked, and powerful, there will be increasingly rich opportunities to develop on-the-go gaming.

Casual games are simple, easy to learn, and can be played in a short time. Puzzles, visual challenges (such as Tetris), number games (such as Sudoku), word games, matching games, and trivia games are examples of casual games. Brain games are casual games intended to maintain or improve cognitive and reasoning skills. Casual games often appear on mobile handheld devices like PDAs and cell phones, but can reside on any game platform such as computers, the web, DVDs, and interactive TV.

Games for learning employ principles of interactive media instructional design to create interactive experiences in which players may achieve one or more of the following: increase their engagement in the topic, become more motivated to learn, change their attitudes, develop self-confidence, learn new content, develop deeper understanding, or learn and rehearse new skills, to name a few of the learning-related outcomes that could occur. Research in this field is helping us develop strategies and principles for the effective design of interactive games targeted to specific groups, such as by gender or culture or skill level, and especially by age, taking into consideration children’s and adolescents’ developing cognitive, physical, social, and emotional needs and abilities.

Games for health apply health promotion and health communication strategies along with the pedagogical strategies used more generally in games for learning, in order to produce better health outcomes. Games have been designed to increase the health-related knowledge and skills of the general public and health professionals in the areas of prevention, selfcare, adherence, health decision-making, disease management, clinical care, and emergency response. There are also games designed to diagnose neurological and mental health disorders, assess and adjust medication dosage, improve self-esteem and mental health, provide biofeedback, distract patients during painful or anxiety-ridden procedures, motivate activities involved in physical therapy, and provide phobia therapy.

Exergames are games for health that get the player moving, using physical challenges and interfaces that require movement and exertion. They involve the player in dance, aerobics, kick-boxing, sports moves, martial arts, biking, virtual window washing, or other forms of physical activity. Examples of commercially popular exergames are Dance Dance Revolution (in which the player must tap specific areas of a dance pad in time with music, using feet and sometimes hands), EyeToy Kinetic (using a camera-based interface that puts an image of the player on the screen so the player can interact with objects on the screen), and games played on the Nintendo Wii platform. Research finds that exergames are appealing, motivating, and fun, and offer compelling game challenges, a chance to perform athletically or expressively, and a way to meet and interact with others in friendships and communities. Studies find that certain exergames improve players’ stress management, weight management, fitness, and health.

An interactive game can occur in a standalone digital environment, such as on a computer with game software or on a TV that displays a game DVD. In addition to displaying a game on a screen, a standalone game can be embodied in a smart toy or robot or haptic device (that senses physical force), for example, to convey messages and to enable interactions that are not possible on a two-dimensional screen. Also, for some games a network such as the Internet links people so they can communicate and play digital games together on their computers or cell phones or TVs, and they can send and receive game-related content. Furthermore, some games occur in the physical world, supported by standalone or networked digital technology. Geocaching is an example of a real-world game supported by wireless online technology and a global positioning system (GPS) that indicates the player’s longitude and latitude. The tag line for this game is, “The sport where you are the search engine.”

Context-aware games take place in the physical world, like Geocaching does, and they use data and information from the environment as inputs into the game. A context-aware game uses both physical and digital information about the player to determine the player’s current progress and game state. Information can come from four types of sources: (1) the environment (location of the player, location of items in the environment that may contain radio frequency identification (RFID) tags or sensors), (2) physical activity (movement of the body such as reaching or tossing, or movement that changes the player’s geographical location), (3) body data (brain waves, stress level, breathing rate, heart rate, galvanic skin response, emotional state), and (4) other people (their comments, votes, recommendations, interpretations, and descriptions).

Following are some examples of context-aware games. The gesture recognition capabilities of the Nintendo Wii video game platform and the EyeToy camera-based system use physical activity as an input; players perform actions in the physical world that they want to perform in the digital game. These technologies are now affordable, popular, and can be used at home, and they are intuitive, easy to use, and know no age barriers. The brain wave sensors used in biofeedback games such as Journey to Wild Divine are examples of the physiological data that can be input into context-aware games. GPS is used in location-based games such as the Japanese game, Mogi, where players explore their physical surroundings to collect hidden virtual items. Players interact with the Mogi world via software on their GPS-equipped mobile phone. As they move throughout the (real) city, the software updates their position and lets them know when they are near any virtual tokens they could collect. Their goal is to gather as many tokens as possible, trade them with other players for rarer tokens, and build the ultimate Mogi collection. Players move throughout the real world and their geographic location is the main source of context within the digital game. Their physical location determines the kind of experience and feedback the game provides. Games that use the player’s location as an input to the game experience are sometimes called pervasive games because they extend the gaming experience off the screen and into the player’s natural, physical world.

Context-aware games can be designed to be played anywhere, making the entire world into a game environment and making anyone the player meets a potential character in a game (if that person is playing the same game or sees the game for the first time and wants to join in). When this happens, daily life could take on an added dimension of being a game, itself. Normal daily activities such as driving to work, shopping in the grocery store, or crossing a street could become activities that affect players’ progress in the narrative of a game. Players could play alone or receive ideas, clues, opinions, and expertise from other players as they make choices and take action. Some context-aware games, including location-based games, are improvisational in nature and depend on ideas and inputs from other players. They generate interesting stories and interactions that were never programmed or produced. This adds freshness to the experience and puts control in players’ hands, for a much lower cost than the pre-produced console games being sold today.

Off-the-screen games are a form of context-aware games that mainly take place in the physical world, with technology serving as a support and information source. In these games, people interact with each other and the drama unfolds in the real world. Alternate reality games are off-the-screen games that insert fictional content into the same media and tools used mainly for real-world, nonfiction purposes, including newspapers, magazines, the web, e-mail, and phones. A player may receive a phone call from a fictional character, intended for the player’s game character, and the player must play along in the fictional story.

Other definitions of “game,” found elsewhere

The definition of “game” I offered at the beginning of this discussion – “a rule-based activity involving challenge to reach a goal” – is intended to be as basic and all-inclusive as possible. Here are a few more definitions I found, and they provide related concepts.

• A contest with rules to determine a winner.
• A contest, physical or mental, according to certain rules, for amusement, recreation, or for winning a stake; as, a game of chance; games of skill; field games, etc.
• To play for a stake or prize.
• Players select actions and the payoffs depend on the players’ actions.
• Players in conflict directly interact in such a way as to foil each other's goals.
• A scheme or art employed in the pursuit of an object or purpose; method of procedure; projected line of operations; plan; project.

And finally, here’s a definition from Wikipedia:

A game is a structured or semi-structured activity, usually undertaken for enjoyment and sometimes also used as an educational tool….Games are generally distinct from work, which is usually carried out for remuneration, and from art, which is more concerned with the expression of ideas. However, the distinction is not clear-cut, and many games may also be considered work and/or art. An example of a game is chess. You use your brains to solve the game and win the game. Key components of games are goals, rules, challenge, and interactivity. Games generally involve mental or physical stimulation, and often both. Many games help develop practical skills, serve as a form of exercise, or otherwise perform an educational, simulational, or psychological role.

Conclusion

I hope the definitions of “game” you have seen here, along with examples of a few game features, game types, and technologies, are helpful and they stimulate your game design ideas and creativity. We have seen only the tip of the iceberg in today’s games and many other exciting game ideas are waiting to be created. The potential is vast, so have fun while you explore new ways to play interactive games that improve health and health care. Good luck!

Debra Lieberman is a communication researcher at the University of California, Santa Barbara. Her research focuses on processes of learning and health behavior change with interactive games.