Packy & Marlon, an interactive adventure video game that uses experiential learning to improve self-management of diabetic children and adolescents, was evaluated in a six-month controlled trial. In the game, youngsters play the role of a character that has diabetes; they manage their character's blood glucose monitoring, insulin use, and food selections for four simulated days, while the character tries to save a diabetes summer camp from marauding rats and mice. Keeping their character's blood glucose within the normal range, through appropriate insulin and food, helps players win the game.

Study participants were young people ages 8 to 16 who were outpatients of diabetes clinics at Stanford University Medical Center and at a Kaiser Permanente clinic. Each participant received a video game system at an initial clinic visit and was randomly assigned to receive either Packy & Marlon (treatment group, N = 31) or an entertainment video game containing no diabetes-related content (control group, N = 28). They could play their video game at home as much or as little as they wished, as long as they followed their family's rules about video game playing. Participants were interviewed in person, and a parent filled out a questionnaire, at baseline, three months, and six months.

Participants in both the treatment group and the control group played their game for an average of about 34 hours over six months, or about 1.5 hours per week, during their leisure time. After six months the treatment group, but not the control group, experienced higher perceived self-efficacy for diabetes self-management, increased their communication with parents about diabetes, and improved their daily diabetes self-management behaviors (e.g. monitoring blood glucose levels regularly, taking insulin as needed, eating the right foods). The treatment group had a 77-percent decrease in diabetes-related emergency and urgent care clinical visits. The treatment group and control group both began the study with an average of about 2.4 diabetes-related emergency and urgent care visits per child per year. In six months the treatment group dropped to a rate of 0.5 visits per child per year. The control group did not change, remaining at 2.4 visits per child per year.

This study demonstrates that well-designed action-adventure video games can significantly improve learning, skill development, and behavior change. Video games can be highly appealing and motivating learning environments in which players have unlimited opportunities to rehearse skills, receive immediate feedback on performance, obtain and make use of information, experience social support when interacting with other players, and develop the confidence and ability to carry out new skills in their daily lives.

Lieberman, D.A. (2001). Management of chronic pediatric diseases with interactive health games: Theory and research findings. Journal of Ambulatory Care Management, 24(1), 26-38.

In clinical trials, children and adolescents learned about health, increased their health-related self-efficacy, improved their self-care, and reduced their emergency and urgent care clinical visits after playing health education video games aimed at asthma self-management, diabetes self-management, and smoking prevention. The video games were designed on the basis of well-established theories of learning and behavior change, including social cognitive theory, successful health promotion strategies and theories, and validated principles of interactive media instructional design.

ASTHMA: Three studies of an asthma self-management video game, called Bronkie the Bronchiasaurus, found improvements in attitudes, behaviors, and outcomes. The first, a clinic-based pretest-posttest study of 50 asthmatic children, found that their asthma-related self-concepts, social support, knowledge, and self-care behaviors improved within a month after they first played the asthma video game. The second study was a randomized experiment in which playing the asthma video game for 30 minutes was contrasted with watching a 30-minute videotape about asthma self-care. Children who played the video game experienced a gain in asthma-related self-efficacy while those who watched the videotape experienced a drop in self-efficacy, most likely because the videotape presented a great deal of "how-to" information but offered no opportunity to rehearse those skills. The third asthma study involved observation of children who were hospitalized with asthma emergencies and had access to the asthma video game in the hospital. Observers noted that the children played the asthma video game extensively and usually played it with other hospitalized children; the game served as a springboard for discussion with peers and caregivers about asthma; and parents were pleased that their children had access to the game.

DIABETES: A diabetes self-management video game, called Packy & Marlon, improved children's self-efficacy and social support, and reduced diabetes-related emergency and urgent care visits by 77 percent, when diabetic youngsters had the game at home for six months; there was no reduction in clinical visits in a control group of diabetic youngsters who took home an entertainment video game that had no diabetes-related content.

SMOKING PREVENTION: A pretest-posttest study of a smoking prevention video game, called Rex Ronan, found it was effective in teaching pre-adolescents about specific ways tobacco can harm the body, and this strengthened their anti-smoking attitudes and their resolve not to start smoking.

Lieberman, D.A. (1999). The researcher's role in the design of children's media and technology. Chapter in A. Druin (Ed.), The design of children's technology. San Francisco: Morgan Kaufmann Publishers.

There is an art to designing children's media and there is a science to it, too. Researchers who specialize in children's media can make valuable contributions to production teams by applying behavioral science research to the design of content, interfaces, and technology for young people.

The chapter discusses seven areas in which a researcher can contribute: (1) specifying the product concept and goals; (2) designing the product for the target user group; (3) obtaining funding to support product development and evaluation; (4) testing the product, before it is completed, with youngsters in the target user group, and revising it accordingly; (5) measuring outcomes by conducting beta tests, field trials, and pilot studies with the finished product; (6) publishing research outcomes and presenting them to potential customers, partners, and investors; and (7) keeping producers and their teams up-to-date on current research, industry resources, and product design trends.

The author has been involved in the development of dozens of software and technology products. She shares examples drawn from her own professional experience to explain how she and other researchers contributed to the seven product development areas, and focuses especially on the researcher’s role in designing and evaluating an asthma self-management video game called Bronkie the Bronchiasaurus. She concludes that a media researcher can contribute a great deal to interactive products, to assure that they are developmentally appropriate and tailored to individual needs and abilities, socially responsible, entertaining, engaging, and educationally effective.

Lieberman, D.A. (1997). Interactive video games for health promotion: Effects on knowledge, self-efficacy, social support, and health. Chapter in R.L. Street, W.R. Gold, & T. Manning (Eds.), Health promotion and interactive technology: Theoretical applications and future directions. Mahwah, NJ: Lawrence Erlbaum Associates, pp. 103-120.

Principles of health promotion and interactive media learning have been integrated into the design of health education video games for children and adolescents. The video games are designed to enhance several intervening, or mediating, cognitive and behavioral factors that make a significant contribution to improving health status. The factors include (1) attention to and active processing of health promotion messages, (2) motivation to learn about health, (3) health knowledge and skills that are essential for implementing proper prevention and self-care, (4) self-concepts related to health, such as self-esteem and perceived self-efficacy for carrying out desirable health behaviors, and (5) communication about one's own health with peers, family, and caregivers who can provide social support for behavior change. This chapter includes a review of current research that confirms the importance of these factors in improving health behaviors and outcomes. The chapter also presents findings from six studies of the health education video games, demonstrating that appropriately designed video games can improve the mediating factors that are known to contribute to better health.