Monster Appetite: Effects of Subversive Framing on Nutritional Choices in a Digital Game ...

15 Pages·2017·1.71 MB·English

Monster Appetite: Effects of Subversive Framing on
Nutritional Choices in a Digital Game Environment
MariaHwang LenaMamykina
ColumbiaUniversityMedicalCenter ColumbiaUniversityMedicalCenter
622W.168thStreet 622W.168thStreet
NewYork,NY,USA NewYork,NY,USA
[email protected] [email protected]
ABSTRACT relyonnewcomputationalaffordances,fromsocialmediato
Americans’healthhasreachedadangerousobesityepidemic videogames. Videogames,inparticular,presentanincreas-
from overconsumption and unhealthy food choices. In re- ingly popular medium for countering the obesity epidemic
sponse, persuasive games for health encourage healthier andmotivatingindividualstoadopthealthybehaviorsinan
lifestyles typically by providing positive reinforcement for engagingandpersuasiveway[7,17,18,57,70,88]: 42%of
thedesiredbehaviors. However,positivereinforcementisonly allvideogameplayerssurveyedin2013playedhealthgames
oneofthemanypossiblyeffectiveapproaches. Weexplore [72]. These health games often use persuasively narrated
twotypesofmessageframinginanutritiongame,Monster healthmessagesusingthespecificaffordancesoftechnology
Appetite(MA).InMA,players’choicesofhighorlowcalorie [30]inordertoenhancetheiroverallhealthimpact. However,
snacksimpactvisualappearanceoftheirmonsteravatar. MA choosingthemosteffectivepersuasiontechniquesforthese
utilizestwotypesofhealthmessages: subversive,whichen- gamesremainschallenging[9,37,42,57,77,79].Hekleretal.
couragesplayerstomakeunhealthychoicesandfocuseson [40]suggestthatalternativemethodsbeusedforpersuasive
costs, andinoculation, whichencouragesplayerstoeventu- technologiesinhealth,acknowledgingtheroomforimprove-
allydefendhealthychoicesandfocusesonbenefits. Wetest ment in HCI. In this research, we investigate an alternative
messageframing’seffectbytrackingusers’purchasingbehav- waytodesignpersuasivegamestoimproveindividuals’nu-
iorinouronlinesnackshop,Snackazon. Thestudyshowed tritionalchoices. Specifically,weareinterestedindifferent
that when positive messages were embedded in MA mixed reinforcementmechanismsandapproachestocouplingthese
withnegativevisualsthroughthemonsteravatars,participants mechanismswithpersuasivelyframedhealthmessagesthat
exhibitedbettersnackchoicespost-gameplay. couldmeasurablyresultinsuccessfulbehavioralmodification
acrossdifferenthealthandgamecontexts[6,82].
ACMClassificationKeywords
Thevastmajorityofnutritiongamesdevelopedthusfaruti-
H.5.2. Information interfaces and presentation (e.g., HCI):
lizepositivereinforcementandbenefit-orientedmotivational
Userinterfaces.
messages through encouraging healthy behaviors and illus-
tratingpositiveoutcomesofsuchbehaviors. However,these
AuthorKeywords
gamesdemonstratedmixedresultsforbehavioralmodification
Framing;persuasivegames;subversiveapproach;two-sided
[30,73]. Thisapproachcontrastswithanalternativestrategy
inoculation;behaviormodification;nutritionalchoices.
oftenusedinnon-nutritionrelatedcontextsthatemphasizes
losses,costs,ornegativeconsequencesofundesirablebehav-
INTRODUCTION
iors. Emphasizingnegativeconsequenceshasbeensuccessful
TheobesityepidemicisoneofAmerica’slargestpublichealth
inconvincingpeopletoquitsmoking,complywithvaccina-
challengesandagrowingoneintherestoftheworld,onethat
tion,reducesubstanceabuse,andscreenforHIV,skincancer,
createsdisparitiesamongrace,ethnicity,region,andincome.
andbloodcholesterol[75]. Closelyrelatedtothenegativecon-
Currently,over12millionAmericanadolescentsand38%of
sequencesapproachisinoculationtheory[63]throughwhich
adultsareobese[31].
"cognitionscanbestrengthenedbyexposinganaudienceto
In response to these trends, an increasing number of tech- (mild) attacking arguments directed against the protagonist
nologicalinterventionstargetimprovedhealthandwellness. and then countering those negative arguments in the same
Someofthesetechnologiesleveragesuccessfulofflineinter- communication"[29]. Thatis,one’soriginalbeliefinahealth
ventionstrategies,suchaseducationandmotivation;others behaviorbecomesstrengthenedwhenthatbeliefismildlyat-
Permissiontomakedigitalorhardcopiesofallorpartofthisworkforpersonalor tackedbyacounterargument. Thisconstructofinoculationis
classroomuseisgrantedwithoutfeeprovidedthatcopiesarenotmadeordistributed consistentwiththenotionoftwo-sidedcommunicativeappeal.
forprofitorcommercialadvantageandthatcopiesbearthisnoticeandthefullcitation
Ithasbeenshowninmarketingcommunicationthatpeopleare
onthefirstpage.CopyrightsforcomponentsofthisworkownedbyothersthanACM
mustbehonored.Abstractingwithcreditispermitted.Tocopyotherwise,orrepublish, morelikelytotrustsponsorsthatprovideboththepositiveand
topostonserversortoredistributetolists,requirespriorspecificpermissionand/ora negativeargumentsregardingitsbrands[29,35]. Whetherit
[email protected].
CHI2017,May6-11,2017,Denver,CO,USA. beinoculationortwo-sidedappeal,thisapproachhasrarely
Copyrightisheldbytheowner/author(s).PublicationrightslicensedtoACM. beentestedinthecontextofnutritiongames.
ACMISBN978-1-4503-4655-9/17/05...$15.00.
http://dx.doi.org/10.1145/3025453.3026052
Figure1.AvatarsofallstagesinMonsterAppetitefromlight(left)toheavy(right).
In this paper, we describe the design of a persuasive game 24hours. Weexaminedtheparticipants’snackchoicesbefore
forencouraginghealthynutritionalchoices,MonsterAppetite andafterplayingMA(inoculation-orientedvs. subversive),as
(MA)thatutilizesunconventionalpersuasionapproachessuch wellastheirself-reportedreasonsfortheirchoices.
as inoculation, and its evaluation study. In the game, users
MA’sgoalwastoenableitsuserstovicariouslyexperience
are asked to choose snacks of various caloric content for a
excessive snacking via the avatars and expose them to the
monster,whoispresentedasanavatar,andviewtheimpact
negative consequences of that particular behavior. As MA
of their choices on the monster’s appearance. MA delivers
employsavatarsthatshowtheresultsofhigh-calorieintake,
persuasivemessagesintwodifferentforms: 1)visualimpact
theconsequencesofcarelesseatingarevisualandtherefore
ofthesnackchoicesontheappearanceofthemonster, and
"tangible."Theintentionwastopreventtheplayersfromexe-
2)goalsandtext-based,framed messagesthathighlightthe
cutingsuchnegativebehaviorsinreallife,thereforeresulting
healthimpactofthechosensnacks. Theframingofthevisual
inapositiveoutcome[14]. Wewereparticularlyinterestedin
appearanceoftheavatarisskewedinthenegativedirection:
investigatingoriginalapproachestoformulatingmessagesthat
high calorie snacks chosen by users make the monster big,
deviatefromthetraditionalpositiveframing;bothinoculation
cheerless,andsicklyingametime. Low-caloriechoiceskeep
andsubversiveframingexemplifynoveldirectionsthatmay
the monster in its original state until a calorie-threshold is
opennewopportunitiesfordeliveringnutritionalinterventions
reached;onlythentheavatarsgrowinsize. Figure1shows
inaninnovativeandfreshway.
themonsters’growthastheyconsumemorecalories.
Thestudyresultsshowedthatbothtreatmentshadaneffect
Wecombinedtheconsistentlynegativevisualswithpersuasive
onsnackpurchaseprocesses, thoughindifferentcapacities.
framingforthegame’sgoalsandfeedbackmessages. Thefirst
Thetwo-sidedinoculationgroupselectedlow-caloriesnacks
typeofframing,two-sidedinoculation,encouragedplayersto
statistically significantly more at post- than pre-gameplay;
consumelow-caloriesnacksandhadpositively-framedpop-
howevertheirreasonsforchoosingsnacksdidnotchange. In
up messages that highlighted the benefits of healthy snack-
contrast,inthesubversivegroup,snackchoicesdidnotsignif-
ing. Thus, the two-sided inoculation combined both nega-
icantlychangeincaloriccontentpre-postgameplay;however,
tive (visual) and positive (mechanistic and textual) aspects
theseparticipantslistedcaloricreasonsforchoosingsnacks
oflow-caloriesnacks. Thesecondtypeofframing, subver-
statisticallysignificantlymoreatpost-thanpre-gameplay.
sive,encourageduserstochoosehigh-caloriesnacksandhad
negatively-framedpop-upmessageshighlightingthenegative Asaresult,weproposethatcouplingcompellingvisualillus-
impactofunhealthysnacking,whichwerealsoillustratedby trationsofthenegativeimpactofunhealthyfoodswithinoc-
negativechangesinthemonster’sappearance.Thesetwofram- ulationmessagescanbeaneffectivemechanismpromoting
ingapproachescomprisedourtwotreatmentconditions.Inthe healthynutritionalchoices. Ourmaincontributionsinclude:
evaluationstudy,participantswereaskedtofirstchoosesnacks (1)bringingmessage-framingtotheforefrontofHCIcommu-
forthemselves(baseline),thentheywereaskedtoplayMA nity’sattentionasavaliddesignstrategyforpersuasivehealth
andchoosesnacksfortheirmonstersinalimitedtimeframe technologyand(2)suggestinganewapproachtodiscretely
(intervention);finallytheywereaskedtomakeasecondset measuringshort-termchanges(withlimitedsocialdesirabil-
ofsnackchoicesforthemselves(post-intervention). Thispro- ity[81,89])todecision-makingandpurchasinginresponse
cedurecomprisingSession1wasrepeatedforSession2after
tonutritionalinterventionsforpromotinghealthy,nutritional weight,managediabetes,managebloodpressure,buildmus-
choices. Snackazonisatoolthatembodiesthismethod. cle,andgeneralwell-being)andchoosemealsfromrestaurants
accordingtotheirhealthgoals. Therestaurantmenusalways
BACKGROUNDANDRELEVANTWORK includeseveraloptionsandpointsareawardedaccordingto
Here,wecoverthebackgroundon(1)persuasivegame-based therelativehealthinessofthemealsinaccordancewiththe
studies,and(2)messageframinganditsapplicability. healthgoal. OrderUP![38]isagameinwhichplayerstake
a role as a server in a neighborhood restaurant and recom-
Why(Persuasive)Games? mend their customers the healthy options to keep their job.
Gameshavebeenshowntobeasuccessfultoolinencouraging LunchTimeandOrderUP!haveshowntoincreasetheplayers’
participantstoactivelyengageinlearningactivitiesoutside nutritionknowledgeandgeneralfeelingsforself-efficacy.
traditional learning environments [3, 47, 44]. One of the
However,theuseofpersuasivegamesinhealthdoesnotcome
reasons why games are successful in this aspect is because
withoutchallenges;thereareveryfewhealthgamesthathave
they"engageplayersemotionally,socially,andculturally,in
beenscientificallyevaluatedbeyondtestingparticipants’be-
waysthattraditionallearningenvironmentsperhapscannot"
havioralintention. Othershaveyieldedinconclusiveresultsre-
[11]. Inthelastfivetosixyears,asmallbutsignificantbody
gardingtheeffectivenessofgamesasaninterventiontool[36]
of research has been documenting these benefits of (video)
orasmall-to-mediumchangeinbehaviororonlycorrelational
gamesastheybecomeincreasinglydiverse,complex,realistic,
involvement between behavioral intention and change [97].
andsocialinnature[36]. Themedicalandhealthfieldshave
The more inconclusive areas for health game interventions
pickedupthesebenefitsandpositiveeffectsofgameplayand
include physical activity, nutrition, and (un)healthy eating,
haveplacedgreateffortsintogamifyingmedicalinterventions
behavior-oriented research. The conflicting results indicate
[18,48,65,83].
thatadditionalresearchisneeded,andthedearthofresearchon
Asamatteroffact,gameshavehadalonghistoryofbeing usinginoculationandsubversive-framinginnutrition-related
usedasapopulartoolinhealthinterventionandprevention activities incentivized us to develop the web-based calorie
programs[5,7,8,38,77,80,91]. Someusesofhealthgames game,MonsterAppetite.
with promising results include those regarding cancer and
otherdiseases,wherepatientshavetofollowastrictregimen Message-framingandItsRangeofApplicability
fortreatment. Insuchcases,thegameworksasanorganiza- The existing message framing literature suggests that there
tional(remindersandalerts)andmotivational(gamification aretopicsthatworkwellwithnegativemessages,whilethere
aspects)tool[48]. Othersincludevideogamesthatworkasa arethosethataffectpeoplemoreintenselyviapositivemes-
distractionfrompainandotherundesiredbehaviors[54,67]. sages. In the health domain, some success cases for nega-
tivemessagesincludesmokingcessation[75],preferencesfor
Persuasive games are also regarded as a popular tool that
mammography[4],anddrugabuse[19]. Ontheotherhand,
havegarneredattentionastheyhaveshownsomepositiveef-
somesuccesscontextsforpositivemessagesincludeuseof
fectsonmotivatinghealthybehaviors[12,16,38,48]. Some
sunscreen[86],seatbelts[98],andcondoms[59].
persuasive games for health promotion and prevention are
introduced here. Lunch Crunch [76] makes players fill out Rothman et al. [84] explains why certain health messages
lunchtrayswithhealthyitemssuchasfruitsandvegetables workwithparticularframes: ifthetargetbehaviorisseenas
andtrashunhealthyitemssuchassweetstoeducatetheplay- riskyanduncertain(detectionbehavior)peoplerespondwell
ers on (un)healthy options. In Escape from Diab [93], the to negative-framing, while if the target behavior is viewed
protagonist tries to escape the dreary land Diab by training as safe and certain (prevention behavior) people react well
others to increase their physical strength by healthy eating to positive-framing. Negative-framing in particular works
and exercising. A good guy encourages the player towards wellinmanyhealthcampaignsbecauseofnegativitybias(a
healthygoalattainment. Abadguydistractstheplayerfrom heightenedsensitivitytonegativeinformation)[85]andfear
attemptingtoobtainthatgoal. Thistemptationvoice,along- appeal[68].
sidethegoodguy,istheinoculationconstructthatisapplied
In a non-health domain and recent example of successful
here. Tothebestofourknowledgethisistheonlynutrition
negative-framing,astudyinvestigatedaself-monitoringsys-
gameincorporatinginoculationtothisdate.
tem for personal productivity with a Korean audience [52].
FatWorld[74]isagameaboutpoliticsandnutrition. Unlike TimeAwareisanappdevelopedtopromoteself-awarenessof
mostnutritiongames,thegoalofthisgameisnotsolelyabout individual’sproductivityviaaweb-basedvisualinformation
choosing a healthy diet, but also about demonstrating the dashboard on computer usage. One version of TimeAware
complexityofissuessurroundingnutrition,suchasbudgets, displayedproductiveactivities(positiveframing),whilethe
the physical world, subsidies, and regulations. Players can otheremphasizeddistractingactivities(negativeframing).The
chooseastartingweight,healthconditions,whattoeat,and 8-weekstudyresultedwithonlynegatively-framedversionof
whethertoexercisewhileservingfoodthroughtheirrestaurant theinterventionleadingtoastatisticallysignificantincrease
business. inparticipants’productivity.
LunchTime[71]isarole-playingslow-casualgameinwhich Ahn et al. [1] conducted an environmental virtual simula-
players choose a health goal out of five options (manage tionexperimentthatcontainedpositively-(experiencingthe
growth of a seedling into a tree by watering and pumping
nutrients)andnegatively-framed(experiencingcuttingdowna
treewithavirtualchainsaw)groups. Afterthevirtualactivity,
waterwas"accidentally"spilledandparticipantswerehanded
pre-countedpapernapkinsforcleanup. Thisveiled,discrete
behavioralmeasureofcountingtheusednapkinsshowedthat
bothconditionsusedsignificantlylesspapernapkins(25%less
thanbaseline)thanthecontrolgroupdid,supportingframed
experiences. Also,thepositiveconditionelicitedgreaterenvi-
ronmentalbehavioralintentionsthanthenegativeone.
Asillustrated,message-framinghasbeenutilizedinmanydif-
ferentfieldswithresultsthatvarytremendouslydependingon
thecontextaswellasmanymediatingfactorssuchasrelevance
Figure2. AscreenshotofasubversiveMonsterAppetitegameinstance
andsaliencetoanindividual,culturalbackgrounds,attitudes, attheendofDay2withanegatively-framedmessageatthetopofthe
risk-perception,detectionvs. preventioncharacteristics[82]. screenasagreenbanner.
MonsterAppetite Two-sidedInoculationGame
Monster Appetite (MA) is a game that strives to remediate Participants in this group played MA as a two-sided inocu-
some aspects of the obesity epidemic by promoting aware- lation game. This version was the same game used by the
nessofthecontentoffood,particularlyregardingper-serving subversive group, except that the game’s goal was flipped
calories. Thesubversivefactor(i.e.,consuminghighcaloric andthepop-upmessageswerepositive. Thegoalofthetwo-
content food items to make one’s monster avatar unhealthy sidedinoculationMAwastoconsumelow-calorieitemsto
andoverweight)raisesplayers’awarenessofhighcalorieval- keepone’smonsteravatarhealthy,fit,andactive. Afterthe
ues of common snacks. In MA, at the end of three rounds caloriesofeachdaywereaddedtothetotalconsumedcalo-
(whichconcludesadayingametime)framedmessagespop ries,apositively-framedmessagepoppeduptoemphasizethe
up to summarize the avatar’s consumption of that day (Fig- monster’sstate(Figure3).
ure2and3). Twotypesofframedmessageswereemployed:
SUMMARY OF DAY 4: You ate 427 calories today. The
positively-andnegatively-framedmessages,withtheframing
LOWESTpossiblecaloriesyourmonstercouldhaveconsumed
highlightingthebenefitsandcostsfromfollowingaspecific
todaywas386. Ifyouhadeaten41FEWERcaloriestoreach
healthregimen[2,15]. Thefollowingsectiondescribesthe
theLOWESTCALORICconsumptionofDAY4,youwouldbe
twoversionsofMAthatwereimplementedwiththetwotypes
ataLOWERRISKforacardiovasculardisease.
offramedmessages.
SubversiveGame
ParticipantsinthisgroupplayedMAasasubversively-framed
game.Thatis,thegame’soriginalgoaltoconsumethehighest-
caloriesnackitemstokeeptheirmonsteravataroverweight,
sluggish, and inactive was maintained and the end-of-day
pop-upmessageswerenegativelyframed. Forexamplethe
followingtypeofnegativemessagewouldpopup:
SUMMARY OF DAY 2: You ate 2602 calories today. The
HIGHEST possible calories your monster could have con-
sumedtodaywas2892. Ifyouhadeaten290MOREcalories
toreachtheHIGHESTCALORICconsumptionofDAY2,you
Figure 3. A screenshot of a two-sided inoculation Monster Appetite
wouldbeataHIGHERRISKforacardiovasculardisease.
gameinstanceattheendofDay4withapositively-framedmessageat
thetopofthescreenasagreenbanner.
Themonstercouldgetfatterorstaythesamedependingon
how many calories were consumed. There was a total of
Notethatonlythegoalofthegame,andthetexthavechanged.
sevenmonsterstages(Figure1)andeachmonsterincreased
Wechosenottouseothervisualcues,suchasdisplayingthe
itssizetothenextmonsterwitheveryadditional1500calo-
negativemessageinredtext,toavoidintroducingmorevari-
ries consumed. There was not an option to go back to an
abilityintheresults. Thestudytookaconservativeapproach
earlier/healthierstageeveniftheminimallypossiblecalories
toframingsothatanyresultscouldbeclearlycorrelatedtothe
were consumed. Therefore, the goal was to feed the mon-
contentofthemessageframing.
sterhigh-caloricsnacks,theframedmessagesemphasizedthe
negativeconsequencesofsuchbehavior,andtheavatarem- Asinthesubversivegame,themonster’ssizechangedaccord-
bodiedthoseconsequencesinavisualmanner. Thisdefined ingtothecaloricconsumption.Themonstercouldgainweight
thesubversivegamegroup. orstaythesameinsizedependingoncaloriesconsumed. Be-
causebothgamesstartedwiththehealthiestmonsteravatarand
playersonlyobservedheavierstagesoftheavatarsascalories
accumulate,theavatarsonlydisplayednegativeconsequences.
Hence,forthisinoculationgametheframedmessageswere Chips,andGarlicRyeChips. Theotherthreepagesincluded
positiveandmonsteravatarsservedasthenegativesideofthe imitateditems[43],butparticipantsweretoldthatallitems
two-sidedappealorinoculationconstruct. werereal. Forexample,fortheimitateditemsapagecould
include three types of pretzels that appear the same except
Snackazon: DiscretePost-ManipulationMeasure forthepackaging(Figure5). Theonlywaytodistinguishthe
In addition to developing Monster Appetite, we wanted to items(besidestheirpackaging)wastoclickontheinforma-
create a platform that would allow us to measure pre- and tioniconbeloweachsnackitem. Therealsnackswereonly
post-gameplaynutrition-relatedactivitiesthatwasnotaself- includedtodistractparticipantsfromfiguringoutSnackazon’s
reportmeasure,sinceself-reportsareoftensubjecttosocial realpurpose. Therealsnackscouldnotbeusedbecauseof
desirabilityandinaccuracy[89]. confoundingvariablessuchasbrandloyalty,allergies,prefer-
ences,familiarity,taste,etc. Thecategoriesofthesnackswere
pickedbythemostpopularAmericansnacks[20]thatwere
commonlyavailableingrocerystoresandhadhighcalories
[99].
Figure5. AscreenshotofSnackazonshowingtheincreasinginforma-
tionprovidedtotheuserbyclicking"GetInfo"and"GetMoreInfo"
buttons.
Figure4.AscreenshotofaPurchaseDecisionQuestion(PDQ)pagewith Eachitemhada"GetInfo"buttonunderit(Figure5). This
threeitemsselectedintherightboxinorderofimportance.
buttonwasplacedundereverysnackonallfivepages. Once
clicked,the"GetInfo"buttondisplayedIngredients,Source,
Therefore,wedevelopedanonlinesnackmarketforpartici-
Per-servcalories,anda"GetMoreInfo"button. Ingredients
pantstogoandchoosesnacksfordelivery. Thissite,Snack-
listedtwoofthemajoringredientsofasnack. Sourceincluded
azon, was used as a pre- and post-manipulation measure to
whetherthesnackitem’smainingredientsweregrownlocally
evaluateparticipants’nutritionalchoices. Thesitetrackedpar-
ornon-locally. Per-servcaloriesshowedtheper-servingcalo-
ticipants’information-seekingbehavior(information-seeking
ries of the snack. For the real snacks the "Get More Info"
behaviorwascapturedbytheirclicksonnutritionbuttons)and
button revealed the sugar and fat information based on the
foodchoices(purchasesofthesnacks)andwhetherthefood
items’realnutrition. Fortheimitateditemsbothsugarandfat
purchasesweremediatedbytheitems’nutritioninformation.
contentwereimitated. The"GetMoreInfo"buttonallowed
Assuch,Snackazonpresentedareasonablecompromisebe-
participantstolookupfurtherinformationaboutthesnacks.
tweeneasy-to-capturebuthighlyunreliableself-reports,and
Thepurchasedecision-makingprocessincludedtwobehav-
capturingindividuals’nutritionalchoicesintherealworldand
iors:selectingsnacksonSnackazon(SnackazonItemChoices,
inthecontextoftheirreallives. Whilethisapproachcanonly
SIC) and choosing reasons that influenced the selection of
showshort-termimpactofnutritionalinterventions,itavoids
theSnackazonitemscollectedthroughPDQs. Allsnackshad
themostcriticalpitfallsofself-reportswhilestillprovidinga
differentper-servingcalories,andwerecategorizedas"Bad"
low-costwayofassessingnutritionalchoices.
(highestper-servingcalories),"OK"(middleper-servingcalo-
Every participant was exposed to five different pages with ries), or "Good" (lowest per-serving calories) choices, and
snacksandaPurchaseDecisionQuestion(PDQ)page(Fig- werecodedas-1,0,and1respectively. Then,thethreecoded
ure4)thatappearedattheendofthosefivepagesofsnacks. valueswereaddedtogethersothatthehighestnumberwould
Eachsnackpagecontainedthreesnacksofsimilartype. Col- representthelow-caloriechoiceandviceversa. Theimitated
laborationwithourteam’sdesignexpertsledtothethree-snack snacksweremadetorepresentcategoricaldatawithoutmean-
perpagedesign,whichavoidsoverwhelmingparticipantswith ingfulvarianceinthecategories. Ourteamspecificallycreated
toomanychoices. Twopagesincludedrealsnackitems. For threecategories(low,medium,highcalorie)toobserveclear
example,apageincludedRitzToastedChips,RufflesPotato
indications of the users’ decisions and whether they would Session Activities
jumpfromonecategorytoanotherpost-intervention. DemographicsQuestionnaire(DQ)
FoodFrequencyQuestionnaire(FFQ)
The PDQ aimed to find out what factors influenced partici-
Snackazon(Rounds1-5)
pants’decisionswhenchoosingsnacksviaSnackazon. PDQ
PurchaseDecisionQuestion(PDQ1)
askedparticipantstorankthetopthreefactorsthatinfluenced
Session1 BehavioralIntentionQuestion(BIQ1)
theirsnackpurchases. Sincewewereonlyinterestedinper-
Gameplay(MonsterAppetite)
servingcalories,theanswerswerecodedas3(=per-serving
BIQ2
calorieswasrankedfirst),2(=per-servingcalorieswasranked
Snackazon(Rounds6-10)
second), 1 (= per-serving calories was ranked third), or 0
PDQ2
(= per-serving calories was not selected). Here, again, the
highest number represented the most desired outcome and 24HOURSLATER
lowestnumber–theleastdesiredoutcome. Ourmainquestion Snackazon(Rounds11-15)
herewaswhetherthechosensnackwasthelowestincalories. PDQ3
These data, the calorie content of the chosen snack and the BIQ3
reasonforchoosingit,providedapictureoftheparticipant’s Gameplay(MonsterAppetite)
Session2
decision-making process about snacks at point-of-purchase BIQ4
andhelpedusassesstowhatdegreecaloricinformationabout Snackazon(Rounds16-20)
snacksmediatedpurchasingdecisionsonSnackazon. Snacka- PDQ4
zonuseddeceptioninthateventhoughtheparticipantswere Exitsurvey&Remuneration
told their selected snacks would be delivered to them, they Table1.Thechronologyofthestudy.Refertoallappendices.
didnotreceiveanysnacksintheend. Thiswasdebriefedto
everyoneatthefinalstageofthestudy. two-sidedinoculationgamegroupwouldhave. Thishypothe-
siswasbasedonplayers’high-engagementandpositivefeed-
EVALUATIONSTUDY backwithMonsterAppetite’ssubversivemechanismfromthe
We deployed our between-subjects design study online to pilotresults[46].
evaluatetheeffectsofframingbycomparingthetwoversions
ofMonsterAppetite,subversiveandtwo-sidedframingusing StudyDesign
inoculation. This study compared two treatments (subversive and two-
sided inoculation approach) in a digital game environment,
Participants and participants were evaluated on how they snack habitu-
The target population for this study consisted of adults 18 ally(i.e.,snackingbehavior)throughafoodfrequencyques-
and over. Recruiting was conducted through social media tionnaire (FFQ—Appendix B) before they were randomly
sites (e.g., Twitter, Facebook, and LinkedIn), and Amazon assignedtooneoftheframedtreatments. Morespecifically,
MechanicalTurk. thesubversively-framedgroupplayedthegamewithagoalof
consumingthehighestper-servingcaloricitemsandobserved
Thisstudyusedapre-andpost-,betweensubjectsdesign. 225
thenegativeconsequences,orlosses,ofexcessivecaloriccon-
participantsenrolledinthestudyandofthoseparticipants105
sumptionwithingametime. Theother,two-sidedinoculation-
wereinthesubversivegroupand120inthetwo-sidedinocula-
framedgroupplayedthesamegamewiththegoaltoconsume
tiongroup. Amongtheinitial225participants,136completed
thelowestper-servingcaloricitemsandobservedthenegative
Session2ofthestudy. Amongthe136returnees58werein
consequences,orlosses,ofmoderatecaloricconsumption.
thesubversiveand79wereinthetwo-sidedinoculationgroup.
Therefore,60.4%ofthe225participantscompletedSession2 Pre-questionnaireswerepresentedtoparticipantsfollowedby
(Nsession1=225,Nsession1&2=136),whichoccurredatleast24 thefirstgameplaysession,whichwasimmediatelyfollowed
hoursaftercompletionofSession1(Table1). Thestudywas by post-manipulation measures. This concluded Session 1.
approvedbyaneastcoastuniversity’sInternalReviewBoard Session2wasconductedatleast24hoursaftertheconclusion
(AppendixG). ofSession1(Table1). Manypreviousfood-relatedresearch
studiesconducteddelayedteststostudythesustainabilityof
ResearchQuestions theinterventioneffect. Ourteamtookasimilarapproachbut
(1)Howdoesthedifferenceinframingofgameplay(sub- giventhebrevityoftheinterventionthedelaybetweenthetwo
versivevs. inoculation)affectfoodpurchasesimmedi- sessionshadtobebrief. Session2repeatedthesameactivities
atelyafteraparticipantfinishesplayingagame? inSession1,exceptfortheinformedconsent,demographics
(2)Howdothegameplaytreatments(subversivevs. inoc- survey(DQ—AppendixA),andfoodfrequencyquestionnaire
ulation)affecttheinclusionof"per-servingcalories"as (FFQ—AppendixB).Thetwosessionsallowedparticipants
oneofthereasonsbehindfoodpurchasesinSnackazon? toplaythegametwiceoverapproximatelya24-hourperiod.
Our hypothesis was that participants in the subversively-
DataAnalysis
framedgamegroupwould(1)choose/purchasethelow-caloric
APrioriTests–Thisanalysiswasconductedtoverifythatthe
snackitemsfor(2)caloricreasonsmoresothanthoseinthe
twotreatmentgroupswerenotdifferentintermsofage,gender,
educationlevel,incomelevel,andgameexperience(Table2).
Asymptoticsig. Pre-andPost-GameplaySnackChoices
Category N df Pearsonχ2
(2-sided) This section explores the paired samples t-test of the snack
choicespre-andpost-gameplay. AsshowninTable3,there
Age 225 5 2.996 0.701
wasastatisticallysignificantdifferencebetweenpre-andpost-
Gender 225 2 1.222 0.543
gameplaysnackchoicemeansinSession1(M=-.392,SD=
EduLevel 225 3 3.267 0.352 1.64,t(78)=-2.12,p=.037)butnotinSession2inthetwo-
IncomeLevel 225 4 5.235 0.264 sidedinoculationgroup. Also,whenthesnackchoicemeans
GameExpr. 225 4 4.702 0.319 ofSession1pre-wascomparedtoSession2post-gameplay
in the two-sided inoculation group, there was a statistically
Table2.Chi-squaretestsforpreliminaryvariables. significantdifference(M=-.494,SD=1.76,t(78)=-2.49,p
=.015). However,nostatisticalsignificancewasfoundinthe
Becausethesevariableswereordinalornominalinnature,chi subversivegroup. Participantsexposedtopositivemessages
squaretestswereconductedtolookforstatisticaldifferences withnegativevisualsthroughthemonsteravatar(two-sided
betweenthetwogroups. Itwasexpectedthatnosignificant inoculation) picked "better" snacks with lower per-serving
differenceswouldbefound,butifdifferencesweretobefound caloriesamongthesnackchoicespost-gameplay.
furtheranalysiswouldbeconductedaccordingly.
Pre-andPost-GameplayPurchaseDecisionQuestions
Snack Choices–Paired samples t-tests of the pre- and post-
Thissectionexploresthepairedsamplest-testofthereasons
snack choices were conducted to see whether selections
forchoosingsnacksviaPurchaseDecisionQuestions(PDQs)
of snacks differed statistically significantly pre- and post-
pre-andpost-gameplay. Asmentionedabove,thecodedPDQ
gameplay. Asmentionedabove,allsnackitemswerecatego-
scorewasdependentuponwhetherthe"per-servingcalories"
rizedas"Bad"(highestper-servingcalories),"OK"(middle
reasonwaschosenandwhatrankitreceivedoutofthethree
per-servingcalories),or"Good"(lowestper-servingcalories)
options. The means of the scores in each section (PDQ1,
andwerecodedas-1,0,and1respectively. Then,theadded
PDQ2,PDQ3,PDQ4),standarddeviations,andresultsofthe
totalscoresforthethreeroundspersection(pre-andpost-for
pairedt-testcomparisonsacrossalltheparticipantspre-and
Session1and2)wascalculated. Themeansofthesescores,
post-gameplayarepresentedinTable4.
standard deviations, and results of the paired t-test compar-
isonsofalltheparticipantsarereportedintheResultssection. There was a statistically significant difference between pre-
andpost-gameplayPDQmeansinSession1(M =.386,SD
RESULTS = 1.24, t(56) = 2.36, p = .022) but not in Session 2 in the
We explore our results in the following order: (1) a priori subversivegroup. Also,whenthePDQmeanofSession1pre-
testfortheentirepopulation,(2)differencesinpre-andpost- (PDQ1)wascomparedtoSession2post-gameplay(PDQ4)
gameplaysnackchoicesacrosstreatmentgroups,(3)differ- in the subversive group, there was a statistically significant
ences in reasons why snacks were selected through PDQs difference (M = .474, SD = 1.43, t(56) = 2.50, p = .015).
pre-andpost-gameplayacrosstreatmentgroups,and(4)an However, no statistical significance was found in the two-
additionalanalysisonusers’feedbackfortheoverallstudy. sided inoculation group. Participants exposed to negative
messages with negative visuals through the monster avatar
PreliminaryAnalysis: APrioriTest (subversive)chose"per-servingcalories"asareasonforsnack
StatisticalPackagefortheSocialSciences(SPSS)wasused choicestatisticallysignificantlymoreofteninpost-gameplay.
toanalyzethedataandalphawassetat0.05. Thefirststep
Afactortoconsideristhenon-statisticallysignificantsnack
analyzedparticipants’demographicinformation. Achi-square
choices for the subversive group (Table 3). However, PDQ
testofindependencewasperformedtocomparethefrequency
allowedrankingforsnackchoicereasons. Hence,oneexpla-
intheagerangesinthetwo-sidedinoculation(n=120)and
nationisthatthePDQreasonsincluded"per-servingcalories"
subversive(n=105)conditions. Therelationbetweenthese
asoneofthehigherrankedreasonsbytheendofSession1
variables was not significant, (χ2(5)=2.996,p=.701). A
andconclusionofthestudycomparedtothebeginningofit.
chisquaretestofindependencewasperformedtoseeifthere
were any significant relationships within gender, education
AdditionalAnalysis: ”Qualitative”Feedback
level, income level, or prior game experiences between the
Inourstudywedidnotexplicitlycollectqualitativedataondif-
twotreatmentgroups.Nostatisticalsignificancewasfoundbe-
ferentaspectsofthegameplayandotheractivities. However,
tween the two groups in their gender (χ2(2)=1.222,p=
attheendofbothSession1and2,therewasanopportunityfor
.543), education level (χ2(3) = 3.267,p = .352), income
participantstoprovideopen-endedfeedback. Themotivation
level(χ2(4)=5.235,p=.264),andpriorgameexperience
behind this particular way of obtaining qualitative data, as
(χ2(4)=4.702,p=.319) as shown in Table 2. Based on opposedtothemoreexplicitandguidedapproaches,wasto
the preliminary results, we assumed the groups were equal avoid social desirability by minimally soliciting comments.
at the beginning of the study regarding their demographics Ifparticipantsmentionedhowfunorengagingtheactivities
(age, gender, educationlevel, incomelevel, andpriorgame werewithoutprompting,weidentifiedtheirresponseashonest
experience)andstatisticaltestswererunwithoutconsideration -unaffectedbythesocialdesirabilityeffect. Weusedinductive
oftheimpactofthesevariablesonthedependentvariables. thematic analysis to analyze the feedback we received and
foundsomeemergingpatterns,listedbelow.
Condition Pair N Mean Std. Dev. t Sig. (2-sided)
Sess1pretoSess1post -0.392 1.644 -2.121 0.037**
Two-sidedInoculation Sess2pretoSess2post 79 0.063 1.399 0.402 0.689
Sess1pretoSess2post -0.494 1.760 -2.492 0.015**
Sess1pretoSess1post 0.088 1.948 0.340 0.735
SubversiveGroup Sess2pretoSess2post 57 -0.035 1.488 -0.178 0.859
Sess1pretoSess2post -0.140 2.224 -0.477 0.636
Table3.Thepre-andpost-gameplaysnackchoicemeanspairedsamplest-testbytreatmentgroup.***p<.01,**p<.05,*p<.1
Condition Pair N Mean Std. Dev. t Sig. (2-sided)
PDQ1toPDQ2 -0.101 1.364 -0.660 0.511
Two-sidedInoculation PDQ3toPDQ4 79 0.165 1.091 1.340 0.184
PDQ1toPDQ4 0.165 1.245 1.175 0.244
PDQ1toPDQ2 0.386 1.236 2.358 0.022**
SubversiveGroup PDQ3toPDQ4 57 0.263 1.158 1.716 0.092*
PDQ1toPDQ4 0.474 1.189 2.504 0.015**
Table4.Thepre-andpost-gameplaymeanspairedsamplest-testofsnackchoicereasonsbytreatmentgroup.***p<.01,**p<.05,*p<.1
Therewereatotalof74and34commentsattheendofSes- intendedto: peoplefullyengagedinreadingtheframedmes-
sion 1 and 2 respectively (N = 108). All comments were sagesandobservingthechangesinthemonsteravatar’shealth
categorized into eight different topics (SNACK, MA, PDQ, andmoodstatus.Thepilotstudy[46]indicatedthatthesubver-
GEN, MISC, SYST, FUN, and LEARN—Appendix J) and siveapproachwasfunandenticingforthemajority. However,
thenfurtherfinelycategorized. Becausesomecommentscon- regardingframing,wealsoencounteredsomeresistancethat
sistedofseverallargeconceptsthosewerecountedasmore wasindicatedthroughthefollowingparticipant’scomments:
thanonecommentforthepurposeoftallyingdifferenttopics
"The...gameseemedalittleforced...instructionsclearly
thatwerementioned. Whenalluniquetopicswerecounteda
indicatedtopickthefoodsIthoughtcontainedthemost
totalof100and53commentswerecodedforSession1and2
calories, so that’s what I did. Pretty obvious that con-
respectively(N =153). Aftergeneralormiscellaneouscom-
stantlychoosingtheitemswiththemostcalorieswould
ments, feedbackregardingPDQandFUNtalliedatthetop.
eventuallykillthemonster...IfI’dgoneagainstthegame
CommentsregardingPDQmainlyconsistedofwantingmore
instructions by not picking the items with the highest
options(explainedinthenextsection). FortheFUNcategory,
amountofcalories(whichishowIwouldtypicallybe-
welistafewthatillustrateinstancesofengagementthrough
have),wouldthishavebeenagainstyourintentions?"
fun,excitement,learning,andself-reflectioninTable5.
DISCUSSION
PurchaseDecisionQuestionandFeedback
Previous research in technologies for health incorporated a
PurchaseDecisionQuestion(PDQ)pagesparkedsomeinter-
widerangeofbehavioraltheoriesandframeworks[62,66]. In
estingfeedback. Someparticipants(n=19)feltthat(a)they
HCIliterature,thefieldofpersuasivetechnologyforbehav-
didnothave3reasonswhytheymadetheselectionstheydid,
iorchange[37,58,94]hasfacedmixedresults. Hekleretal.
(b)thePDQpagewasshowntothemabittoolatetoremem-
[40]recommendthreewaystoevaluatetechnologiesregarding
berwhytheymadethechoicestheymade,or(c)theitemsdid
behaviorchange: mediationalanalysis,alternativeexperimen-
not cover all the reasons they had in mind for making their
taldesigns,andqualitativedata. Inourwork,wedeveloped
snackselections. Forexample,someofthefeedbackincluded:
analternativeexperimentaldesign,supplementedwithqual-
-"Iwonderwhynutritionfactwasn’tanexplicitoption,"; itative data. We examined whether two relatively untested,
-"Ilookedalotatthesugar/fatcontent...butthatwasn’t alternativeframingapproaches(subversivevs. two-sidedinoc-
oneoftheoptionstodragintothebox,"; ulation)fordeliveringnutritionalmessagesinadigitalgame
-"Formanysnacks,Ionlythoughtabout1or2aspects environment—MonsterAppetite(MA)—wouldaffectpartici-
ofthem,butIwasforcedtochoose3." pants’immediatesnackpurchasingbehavior. Theseemingly
smallandinconsequentialsnackchoicescannonethelessbe
Thoughwereceivedsomepositivecommentsregardingfun highlyimportantbecauseproliferationofenergy-densesnacks
andenjoymentasshowninTable5,wedidnotofficiallymea- iscontributingtothehigh-caloriedietscommontoindividuals
sure engagement during gameplay and Snackazon to see if nationwide[26,34].
the affective appraisal was related to positive game experi-
ences[64]. Therefore,fromthefeedbackaloneitwasdifficult Whyframingorpersuasion?
to see whether the framing and interface worked as it was Deliveringacomplex,nutritionmessageorconveyinghealth-
ful information in a simple way is challenging. In fact, the
Time TOPICS(Subtopic) ExampleQuotes
LEARN(reflection) "Thiswasaninterestingsurvey. Feedingthatlittlegreenguyallthosecaloriesreally
FUN(fun) mademethinkwhatIamputtingintomybodyandhowImightlook. Ialsoenjoyed
Session1
thesetupofthesurvey."(SUBV)
FUN(fun) "Thatwasalotoffun!! I’msorrythatitended. Ihavebeenstrugglingwithgetting
LEARN(reflection) myselftothinkabouteatingbetter. AndIfeltabitdifferentlyafterplayingthegame
about being such a snack-horse. :) It will be interesting to see if I continue to feel
different..."(SUBV)
MA(interface) "During the monster game, sometimes duplicates of certain foods would show
LEARN(informing) up...sometimesIclickedonelater...because...ofcuriosity...[of]calories...Alsoifyou
madeitsothatyouhavecaloriethresholdsandyougetsomethingforthemoryou
’win/lose’forit,itcouldmakeitsoIwanttoclickhighcaloriethingsmore."(SUBV)
LEARN(reflection) "This survey made me really aware of my eating habits and food choices. I will
definitelytrytomakehealthierchoicesinthefuture."(SUBV)
Session2
FUN(fun) "Thatwasfun. Inevercouldgetthemonstertosmileorgetoutofthesilverlevel."
LEARN(reflection) (INOC)
FUN(fun) "Ireallyenjoyedthisgame! Itwasverycleverandengaging..."(INOC)
LEARN(reflection) "I was actually really hoping to get some of those items. Some of them I haven’t
FUN(fun) hadsinceIwasakid...Icouldbuythemnow, but...Iwouldfeelguilty. Thiswasan
interestingandfunstudy. Ireallyenjoyedit!"(SUBV)
Table5.VoluntaryfeedbackfromparticipantsattheendofSession1and2.Theseareafewsamplesthatshow(in)directengagementduringthestudy.
2012FoodandHealthSurvey[32]showedhalfofthosepolled thehealthapp(s)hadimprovedtheirhealth,andamajorityhad
believeddoingtaxeswaseasierthanfiguringouthowtoeat astrongdegreeoffaithinhealthapps’accuracyandeffective-
inahealthyway. Moreover,manystudiesshowedthatsimply ness. Inaddition,asmentionedearlier,persuasivetechnology
deliveringnutritionalinformationintheformofNutritional andgamesinparticular,havebeengeneratinginterestintack-
FactsLabelsatthepoint-of-purchaseproducesmoderateim- lingmotivationforhealthybehaviors[50,70,93]. Giventhis
pactonindividuals’choices[28,55]. Partofthereasonsfor growinginterestinutilizinginteractiveandmobilecomputing
thislackofimpactcouldbethatinformationaldisplaysdonot technologies for health, there is an opportunity to leverage
directlyspeaktoindividualsonhownutritionalchoiceswill successoftraditionalmarketingcampaignsthatrelyonpersua-
affectthempersonally. Therefore, campaignswithtargeted sivelyframedhealthmessagesinthedesignofnewinteractive
messagescanbemoreusefulandmeaningfultoindividualsin interventions. Ourstudyshowedthatthereexistmanynovel
helpingthemtoadopthealthybehaviors[13,27,95]. Nega- opportunitiestoframehealthmessagesandthechoiceoffram-
tivelyframedmessageswereshowntobeparticularlyeffec- ingcanhaveasignificantimpactonbothindividuals’snack
tive: negativelyframedmessageregardingextra-largesodas choicesandtheirreasoningbehindthesechoices. However,
havesuccessfullydecreasedoverallsodaconsumptionnation more research is needed to better understand how different
wide[87]. Similarsuccessfulresultswereshowninregards typesofframingcanbeincorporatedininteractivetechnolo-
to the fat consumption in the 70s (though with unintended giesforhealthandtheresultofthelong-termexposuretothese
consequences)[92]andtothehighlynegative,anti-smoking interventions.
messagesthroughtheTipsFromFormerSmokerscampaign
[69]. As shown through these examples, carefully framed FramingEffectsinaDigitalGameEnvironment
health-relatedmessageshavethepotentialtoamplifytheim- Thisstudydemonstratedthatframingaffectedparticipants’
pactofnutritionalandotherhealthinterventionsanddirectly snack choices and reasons for choosing those snacks
affectournation’shealth. (PDQs) in pre- and post-gameplay (Session 1) as well as
comparing their choices and reasons at baseline and con-
Thenotionofframinghasbeenpreviouslyexploredwithinthe
clusion of Session 2. However, the framing conditions af-
HCI community; yet its framing-based studies have mostly
fectedthesnackchoicesandpurchasingmotivations(PDQs)
been conducted in non-health contexts [39, 41, 51, 52]. At
differently. Thatis,forsnackchoiceswefoundstatistically
thesametime, Web-[10, 33, 49, 78, 90]andmobile-based
significantimprovementsinthetwo-sidedinoculationgroup,
health interventions [21, 24, 25, 53, 61, 79] are on the rise
while for PDQs we found improvements in the subversive
asmoreAmericansutilizeeHealthandmHealthservices. A
groupasobservedinTables3and4.
meta-analyticreviewofweb-basedinterventions[96]identi-
fied85studiesbetween2000and2008andfoundtheyhad Theseresultsindicatethatinbothconditions,exposuretoMA
a statistically small but significant effect on health-related increasedparticipants’awarenessofcaloriccontent;yetthis
behavior on average. A national survey [56] conducted on awareness had different effects in the two conditions. Our
1604adultsmartphoneusersshowedthat58%ofthemdown- focusherewasonthesubversivecondition,whichwaspartic-
loadedatleast1healthapp,65%ofthosesurveyedreported ularlyengagingandattractiveduringourpilots[46].
Previousresearchshowedgamesthatallowtheiruserstoen-
gageinactivitiesdeemedunacceptableorsubversiveinthe
real world may have a particular appeal for certain popula-
tionsthatarechallengingtoreachwithmoretraditionalpublic
healthinterventions[23]. Overall,asthestudyprogressedsub-
versivegroupparticipantscaredabout"per-servingcalories"
statisticallysignificantlymorethantheydidinitiallywhenthey
startedthestudy. Thisgradualappreciationoftheimportance
of"per-servingcalories"ispromisingandisconsistentwith
thenewinitiativeswithintheFDAthatraisepublicawareness Figure6. ThenewproposedNutritionFactsLabel—right—compared
tothecurrentversion—left.Thenewlabelwillbeimplementedby2019.
of calories in foods (Figure 6). Though calories do not tell
thewholestoryasaparticipantpointedout("thingslikepret- provided an interesting picture of some of the participants’
zelsmighthavelowcaloriesbuttheyareemptycalories"),it feelings. IfwecansafelyassumethatFUNandLEARNcat-
is promising that an unconventional approach succeeded in egories from Table 5 indicate a form of engagement, then
bringinganutritionfacttoattention. Theremaybepotential engagement-relatedcommentswerethemostfrequentedtopic.
forthesubversiveframingapproachinemphasizingandlearn- Since the feedback solicitation at the end of Session 1 and
ingoneparticularaspectinnutritioninagameenvironment. 2wasgeneric,askingforanycommentsrelatedtotheentire
Furtherinvestigationisneededtoseeifthisresultappliesto study,itispromisingthatparticipantsdecidedtovoluntarily
othernutritionalaspectsinpersuasive,gameapplications. mentionaspectsthatcanbelargelycontributedtoengagement.
Thecollectionofaffectivedatacanbeusefulingaugingaware-
Yetthishigherappreciationforcaloriesasareasonforchoos- nessanduserexperience[14]toapersuasivehealthtopic,and
ingsnacksdidnottranslateintoincreasedpreferenceforlow- furtheractionstakenbasedonthoseresponsescanbeuseful
caloriefoodchoicesforthesubversivecondition. Thesubjec- ingame-basedbehaviorstudies. Asintrinsicengagement[60]
tiveexperiencesoftheparticipantsmaysuggestaplausible isoneofthebestaffordancesofgames,itwouldbewiseto
explanationtothisfinding. Whilesubversivegameplaymay implementawaytodetectthelevelofengagementwithany
have felt like more fun, it was also perceived as somewhat persuasivehealthgame.
forcedandcontrarytosomeparticipants’naturalinclinations.
Previousresearchsuggesteddifferentindividualsmaybemore
FutureResearchandConclusion
predisposedtodifferenttypesofgameplay,thusdistinguish-
Tofacilitatefutureworkwithinthecommunity,wehavemade
ingdifferentplayertypes[70]. Itispossiblethatsubversive
the tools for this study, Monster Appetite and Snackazon,
gameplayhasapositiveappealonlyforacertaintypeofusers.
open source [45], so that they may provide a foundation
Furtherresearchisneededtoexaminepossibleconnections
forothergame-basedhealthstudies. Specificareasoffuture
betweenindividuals’preferencesinregardstoplayertypeand
researchincludedesigningpersuasivegamesforotherhealth
effectivenessofsubversiveapproachtonutritionalchoices.
contextsandlastingbehaviorchange,makingtheframingand
positive/negativereinforcementsadjustable(e.g.,choosingthe
ImprovingMonsterAppetite
beginningmonsterstage),addingfeaturestoletplayersknow
ThisstudyidentifiedafewopportunitiesforimprovingMA’s
howfar/closefrom"winning/losing"thegame,andbeingable
design. One limitation of the current study was the avatars
toaddhealthgoalstotailorthegameplay.
only changing in the negative direction in both conditions.
Inthetwo-sidedinoculationgame,eveniftheplayerswere Ourworkcontributestothegrowingbodyofliteratureinthe
feedingthemonsterlow-caloriesnacks,eventuallyitfattened persuasivetechnologyandgamesspace,specificallyinnutri-
up. Hence,atnopointdidtheparticipantsreceivepositivere- tion. Wehopethisstudycanhelpdesigners,developers,and
inforcement,norobservegoodconsequencesofhealthysnack- dietitiansfurtherinvestigatedifferentmessagedeliverymeth-
ing. As a result, the two-sided inoculation gameplay may odstoinspirehealthiernutritionalchoices. Along-termfuture
havenotbeenvisuallydifferentenoughthanthesubversive goal is to make a persuasive mobile app that is seamlessly
one,exceptfortheend-of-day,pop-upframedmessages. Ad- integratedinpeople’sdailylives,especiallyforthosewhoaim
dressingthisissuecouldleadtopossiblefuturestudies. For tochangetheircurrentbehaviorinapositiveway[22].
example,ifthemonsteravatarsstartedatmid-weight(stage
Whilewefocusonpersuasivenutritiongames,weexpectthese
fourinFigure1)anddependingonhowwellornotthecalories
resultstogeneralizetootherapplicationsofpersuasivehealth
werecontrolled,thestagescanmovetoahealthierorheavier
game-basedbehaviorstudies. However,documentingframing
stage. Anotherrevisioncouldbethatplayersgettochoosea
effectsingamesisonlythefirststeptosuchageneralization.
startingweightlikeitwasdoneinFatWorld[74]andtheyget
Further research is needed to understand the mechanism of
toseechangesintheavatar’shealthandmoodbasedontheir
the framing effects in persuasive games across application
activitiesexpressedthroughtheavatars. Similaravatar-based,
domains.
visualhealthgamesmaywanttoconsiderflexibleoptionsfor
positiveandnegativevisualfeedbackormessages.
ACKNOWLEDGEMENT
AreWeHavingFun? ThisworkwasfundedinpartbytheNSFSmartandConnected
Thoughnoofficialaffectivedatawascollectedregardingplay- Health(GrantNo. 1551708,PIMamykina)
ers’experiencethroughoutthestudy,thequalitativefeedback