MS Thesis Defense

Utilizing a Modular Approach to Gamification to Improve Nutrition and Fitness in Children

Chad Richards

Committee Members: Dr. Craig Thompson Dr. John Gauch Dr. James Parkerson Outline

• Introduction – Problem – Objective – Approach • Background – The Obesity Epidemic – Gamification • Design – Iterative Design Process – Edufitment Framework – Plugin Game API – Mini-Games – Meta Game • Analysis – Framework – Games • Conclusions – Summary – Contributions – Future Work Introduction - Problem

• Obesity is a worldwide epidemic that affects children – Obesity contributes to four of six leading causes of death: heart disease, stroke, cancer, and diabetes – 40 million children worldwide under the age of 5 are obese – Most obesity studies focus on adults • Gamification, the process of engaging players and solving real-world problems using game mechanics, promises to: – Increase business profitability – Reduce employee monotony – Solve serious issues but gamification is not yet well understood. Introduction - Objective

• Identify and describe the requirements and then develop a methodology and architectural framework for gamifying a specific serious domain: obesity reduction in children Introduction - Approach

• Initially approached by an interdisciplinary team of faculty with backgrounds in nursing, education, and kinesiology to create a single educational video game to combat obesity but … – No one game can please every person – No one game can cover all nutrition and fitness – The core of a large game is fixed • … so the approach changed to identifying requirements to cover a large area of nutrition and fitness education – Create a central framework – Create modular plug-in games, each with different knowledge areas – Create public game API for connecting games to framework – Provide metrics for each game to determine progress Background - The Obesity Epidemic

• Obesity – Having an excessive amount of body fat – Caused by energy imbalance between Calories eaten and energy expended • This means obesity is highly preventable by healthy diet and exercise – Contributes significantly to heart disease, stroke, diabetes, high blood pressure, and cancer • Key Statistics: – 72 million obese Americans; 500 million worldwide – Staggering medical care costs: $147 billion in 2008 in America – Responsible for 95% of total American diabetes cases Background - The Obesity Epidemic

• Obesity extends to children – 33% overweight or obese in America – 40 million children under the age of 5 worldwide are obese • Solution approaches – Incorporate healthier meals in shool • Regulatory issues with solution – Schools must meet a weekly budget – Children are on free lunches, which restrict foods – Require more physical education classes and start PE at younger ages • Budget and time issues with solution • Most PE classes do not take regular measurements for indicators of obesity Background - The Obesity Epidemic

• Solution approaches – Education • Educating adults will likely influence children's health • Education can be literature or discussion groups • Education can lead to better shopping habits and better behaviors related to snacking and foods choices • Our approach – Education through Healthcare Gamification • Provides novel technique that may be especially appealing to children and their families Background - Gamification

• Games – Bring about many ideas • Playground Activities • Sports • Video Games – Associated with entertainment (having fun) – Definition (for our purposes) • Problem-solving activity, approached with a playful attitude – Negative connotations • Time wasting activity • At work, fun is not associated with getting the job done Background - Gamification

• Researchers in gamification are attempting to remove this negative stigma • Gamification – Engage players and solve real-world problems using game mechanics • Game mechanics – Rules of games and procedures involved in games • Gamification is new as a research area but has been around for centuries and is ever-present in society – Military Level Advancement - Levels – Boy Scout Merit Badges - Badges – Airline Loyalty Programs - Reward System, Experience Points, Redeemable Points – Buy 10 Get 1 Free Cards - Reward System, Redeemable Points Background - Gamification

• Gamification of education – Games were popular in education in the early 1990s • The Oregon Trail • Math Blaster • Reader Rabbit • Where in the World Is Carmen Sandiego? – But marketing issues devastated the educational software industry • Budget for educations games was the same as blockbuster titles • Marketers slashed costs to increase market share • This led to competing cost slashing across edutainment industry • Selling prices were down to 10% of original cost • Educational software industry never recovered – Since then, some popular entertaining games have been incidentally educational • SimCity • Civilization Background – Gamification (cont.)

• Game Mechanics – Reward Systems • Use multiple mechanics to entice players to continue playing • SAPS (status, access, power, stuff) – Point Systems • Experience points, redeemable points, skill points, karma points, reputation points – Levels • Mark progress in the game – Leaderboards • Ordered list containing names and scores arranged from highest to lowest score • Incorporate competition into games – Badges • Consist of image along with a badge name; grant status (highest SAPS reward) Background – Gamification (cont.)

• Game Mechanics (cont.) – Quests • Give players direction, telling them what to do next – Social Engagement Loops • Increases game virality - how quickly game becomes popular • Motivating Emotion leads to Social Call to Action leads to Player Re- engagement leads to Visible Progress and Rewards leads to Motivating Emotion – Customization • Give players options, but do not overwhelm them – Dashboards • For the designer instead of the player • Analysis tools that monitor every game mechanic implemented in the system, allowing designers to improve each part Design - Iterative Design Process • Initial idea from multidisciplinary group – Single nutrition or fitness game for elementary children – Make the game available in Spanish and English – Game is to be played in computer lab • Single game has issues – How to please every person? – Little room for improvement – Small domain coverage • Which information to cover? – How to promote good nutrition while encouraging exercise? Design - Iterative Design Process

• Decided that a suite of mini-games is better than a single game – Modular: can add or remove games • Identified requirements for project – Suite of Games • Domain coverage - Each mini-game covers a portion of nutrition and fitness knowledge • Extensibility - Mini-games can be replaced, removed, or improved • User diversity - Mini-games can meet the needs of a diverse population • Measurability/metrics - Mini-games can measure progress • Security/privacy - As much as possible, keep user information and metrics private – Plugin game API • Must provide functions for first and third-party game connections • Must support metrics and internationalization and make security and privacy top priorities – Meta Game • Provides a way to spend in-game currency – Central cloud-based gamification framework • Must allow first and third-party games to connect • Must support social network to enable students to share their aggregate progress with parents, teachers, and other students in competitions. Design - Edufitment Framework

• Central Gamification Framework available on www.edufitment.com • Implemented with a combination of HTML5, CSS, PHP, JavaScript, and MySQL – HTML5 for displaying – CSS for styling webpages – PHP for many uses • Connecting to MySQL database • Providing dynamic content • Defining role permissions for user privacy • Internationalization of website and games • Developing plugin game API • Managing user accounts – JavaScript for displaying games on home page and providing function for closing game windows when a player quits the game – MySQL database consists of five primary tables • currency - provides inflation/deflation of economy and helps balance the number of coins earned from playing games • users - stores all user account information: first name, family name, nickname, gender, role, language preference, system of units preference, username, password, and group in which the user belongs • ISO639 - tied to internationalization of framework, defines list of language codes and English name of the language • game_statistics - generic table used for measuring a user's progress in the mini-games • games - stores information about each game and scores for a round of play Design - Edufitment Framework

• Game mechanics implemented – Point system • Redeemable Points – Dual Currency - ExerCoins and NutriCoins – Earned by playing games, can be spent in Meta Game • Experience Points – Cumulative ExerCoins, Cumulative NutriCoins – Earned by playing games, cannot be spent – Used to track user progress and displayed on Coin Statistics Leaderboard – Dashboard - Displays user progress and allows account information to be modified – Leaderboards and Game Statistics Boards • Each game provides a leaderboard and is displayed both on homepage and game's webpage • Split by overall, top groups, and top students (or players) • Game statistics provide metrics for each game and are displayed alongside leaderboards – Quests - Left for teachers to implement, but can later be developed in-framework Design - Edufitment Framework

• Additional Features – Roles with separate permissions sets for user privacy: • Administrators, Developers, Healthcare Administrators, School Administrators, Teachers, Students, and Players – Security • Only certain roles can access user account information • Plugin game API requires a unique game name and password to use before any user credential is verified • List of approved third-party games is displayed on website – Internationalization • Built directly into framework • Currently supports 4 languages: German, English, Spanish, and French • Can easily add more languages by translating one file • Plugin game API also provides multilingual capabilities for translating game content Design - Plugin Game API

• Provides secure, useful features for first and third-party games – Games must provide unique game name and password before any API function is accessed • Game credentials are checked before user credentials – Functions for: • Checking user credentials (used to associate game play with users) • Submit game statistics (a way to provide game metrics) • Add a player's score (which is then converted to either ExerCoins or NutriCoins) to the database • Retrieve language translations for in-game text Design - Mini-Game - Quiz Show Chad Richards Design - Mini-Game - Quiz Show

• Features – Domain: Unlimited, easy to add new questions and categories – Description: • Similar to Jeopardy, differs in following ways: Player always has control of the board; Player never sees enemy answers; Questions are in the form of questions; Only one level, no double or final level • 24 different enemy AIs – Coin Type Awarded: NutriCoins – Game Statistics: Games Played, Games Won, Percent Questions Attempted, Percent Questions Answered Correctly, Percent Questions Answered Incorrectly, Most Difficult Category – Implemented in Unity 3D • Extensibility: – Can implement difficulty setting based on public ratings – Can change question set based on age group – Can improve enemy AI Design - Mini-Game – Food Group Matchup Taylor Yust Design - Mini-Game – Food Group Matchup

• Features – Domain: Recognizing food groups in which foods belong – Description: • Players match 3+ foods horizontally or vertically • Foods do not have to be identical, but must belong to same food group (Dairy, Empty Calories, Fruit, Grains, Protein Foods, and Vegetables) • Points are earned for correct matches, taken away for incorrect matches • Provides a hint button, which also takes away points – Coin Type Awarded: NutriCoins – Game Statistics: Percent Matched Correctly, Percent Matched Incorrectly – Implemented in Unity 3D • Extensibility – Can add more foods – Can implement new game rules, such as time limits Design - Mini-Game - Calorie Meter Card Game Taylor Yust Design - Mini-Game - Calorie Meter Card Game • Features – Domain: Recognizing Calorie content of foods – Description - similar to Texas Hold'em Poker and 21 (Black Jack) • Players are presented with two hands of cards. Each card represents the total Calories in a single serving of the pictured food. First hand resides in middle of table and represents Calories already in play. Players must select 0-5 cards from second hand (closest to bottom of screen) to add to the Calories in play • To win a round of play, the total value of cards in play must not exceed the Calorie limit and must be at least 80% of the optimal card selection. Calorie Limit is displayed in top right corner of screen, along with a bar on top left of screen • Winning a round earns players points based on choosing the best hand from the available cards. Exceeding the limit or going under 80% of the optimal hand subtracts points from the total score. Players may quit the game and submit their current score at any time – Coin Type Awarded: NutriCoins – Game Statistics: Correct Hands, Incorrect High Hands, Incorrect Low Hands – Implemented in Unity 3D • Extensibility – Can add more foods - This allows for 1500 Calorie and 2000 Calorie hands – Can implement new rules of play - Time limits; Enemy AI Design - Mini-Game – NutriHunt Taylor Yust, Andrew Johnson Design - Mini-Game – NutriHunt

• Features – Domain: Recognizing vitamin, mineral, and macronutrient content of foods – Description - Similar to NES Duck Hunt game • Instead of ducks, players shoot foods matching rule set for the current level. Four rule sets (levels) were produced for the game: Level 1: Unlimited ammo, shoot foods until five vitamins are filled to RDA values. Level 2: Same as Level 1, but now there is a time limit. Level 3: Same as Level 1, except now if foods belonging to Empty Calories group are shot, player loses the level. Level 4: Fill up recommended daily allowance of Vitamin C, but ammo is limited. After Level 4, the game resets to Level 1 with current score maintained. Players earn points for completing levels and lose points for losing levels. Players may quit the game and submit current score at any time – Coin Type Awarded: NutriCoins – Game Statistics: Levels Cleared, Shots Fired, Targets Hit – Implemented in Unity 3D • Extensibility – New levels can be easily added and are highly customizable; Winning/losing conditions can be set, ammo can be limited, and time limits can be imposed – Can add additional foods Design - Mini-Game – 2D Platformer Chad Richards Design - Mini-Game – 2D Platformer Chad Richards • Features – Domain Covered: Recognizing unhealthy foods – Description • Goal is to grab the key and unlock door • Several enemy types implemented – Pie - faster than the player, but limited vertical vision; will chase after player; will not fall off level – Doughnut - simply rolls back and forth – Cupcake - hops toward the player; largest area of vision – Twinkie - slower than the player; will chase player, but will also fall off level • Player gets hurt and grows if unhealthy food is touched; 3 total lives – Coin Type Awarded: Not implemented – Game Statistics: Not implemented – Implemented in Unity 3D • Extensibility – More levels; additional enemies; player abilities, such as temporary invincibility or double jump; collect healthy foods along the way Design - Mini-Game - Out-dance the Elephant / Win the Fight Chad Richards Out-dance the Elephant / Win the Fight • Features – Domain: physical activity - keep heart rate in target range – Description • Several levels with various time options (10, 15, 30, 45 minutes, etc.): Beginner (Heart Rate 60%+); Standard (Heart Rate 70%+); H.I.I.T: Heart Rate (75%+ for one minute followed by 50-75% for 30 seconds); Tabata (Heart Rate 80%+ for 20 seconds followed by 10 seconds of rest). Likely that children will want to follow along with the dance/fight background – Coin Type Awarded: ExerCoins – Game Statistics: Not implemented – Implemented in Unity 3D, Android, and uses Zephyr BioHarness 3 Heart Rate Monitor. Game works but does not provide graphics. • Extensibility – Other body monitors could be used in place of or in conjunction with the Bioharness; graphics and sounds can be added; game statistics can be implemented to provide metrics, e.g., Maximum Heart Rate, Number of Times Elephant Has Been Out-danced, Most Popular Game Mode – Opens up a world of possibilities for simulation heart rate games including Racing games, dancing games, fighting games, etc. Design - Mini-Game - Record Keeper Chad Richards Design - Mini-Game - Record Keeper

• Features – Domain Covered: Metrics game to tracking any user-defined entry over time – Description • User defines name, unit and amount; e.g., SITUPS, Count, 25 • User can add, retrieve or modify entries; x-axis is time and y-axis is amount – Coin Type Awarded: NutriCoins – Game Statistics: Record Count, Most Popular Entries, Most Records – Implemented in primarily with HTML5 canvas element but also CSS, PHP, JavaScript, JQuery, AJAX, MySQL • Extensibility – Provide a complete stand-alone graphics package for HTML5 Canvas element – Add more types of Trend Lines to fit more types of data (log, poly, power, exponential); add options for correlation graph (one entry versus another) or display multiple entries on the graph at the same time Design - Meta Game - Chat Chad Richards Design - Meta Game - Chat

• Features – Domain: users chat with one another and spend coins on sending messages – 3 Message prominence levels: Low, Medium, and High • Low costs 5% of total NutriCoins or 1 NutriCoin, whichever is greater – Basic border around them and in a medium font size • Medium costs 15% of total NutriCoins or 100 NutriCoins, whichever is greater – Thick ridge border around them and in a large font size • High costs 25% of total NutriCoins or 1000 NutriCoins, whichever is greater – Thick blue and black border with drop shadow and are in an extra large, bold font – Invisible moderation using defined roles • Students can not see Administrators, but Administrators can see Students – Students can still see messages sent directly to them from Administrators – Private messages can be sent by clicking the name of a user on the members list • Extensibility – Many types of meta games can be created to be in conjunction with or in place of the chat room, e.g. a Tamagotchi-style pet game: to keep pet healthy requires buying food with NutriCoins, ExerCoins Analysis - Framework

• Set out to adhere to certain requirements: – Central cloud-based gamification framework • Must allow first and third-party games to connect • Must utilize game mechanics • Must make security, privacy, and internationalization top priorities – Plugin game API • Must provide functions for first and third-party game connections • Must support metrics and make internationalization, security, and privacy top priorities • Edufitment provides – Central cloud-based gamification framework at www.edufitment.com • Allows first and third-party games to securely connect to framework through Plugin Game API • Utilizes point systems, leaderboards, and dashboard; quests left for teachers to implement • Provides security and privacy through defined roles and prominent list of approved third-party games – Plugin Game API available for first and third-party games to connect • Provides secure functions for connecting to framework, internationalization, checking user credentials, inserting game scores, and inserting metrics in the form of game statistics Analysis - Games

• Set out to adhere to these plugin-game requirements: – Suite of Games • Domain coverage - Each mini-game covers a portion of nutrition and fitness knowledge • Extensibility - Mini-games can be replaced, removed, or improved • User diversity - Mini-games can meet the needs of a diverse population • Measurability/metrics - Mini-games can measure progress • Security/privacy - As much as possible, keep user information and metrics private – Meta Game • Provides a way to spend in-game currency • Games provide: – Suite of Games: • Domain coverage: – Quiz Show is potentially unlimited because it contains an expandable database of questions and categories – Food Group Match Up, Calorie Meter: The Card Game, and NutriHunt cover nutrition knowledge including the ability to determine which foods belong to which food group, how many Calories are in a serving of different foods, and the quantity and types of vitamins and minerals in foods – Out-dance the Elephant provides a demonstration of how to include an activity game in the framework – Record Keeper provides a demonstration of how users can manually record the results of an open-ended collection of activities and exercises • Extensibility – Each game is extensible in many ways • User diversity – Because there are a wide array of different types of games, each may appeal to a different type of player • Metrics – As described, each game provides a set of metrics in the form of game statistics • Security / Privacy – Defined roles and a plugin game API provide security and privacy for each game – Meta Game • Allows users to connect with one another and spend coins on sending messages, with higher prominence messages costing more coins Conclusions - Summary

• Approached by an interdisciplinary team of faculty with backgrounds in nursing, education, and kinesiology to create a single nutrition or fitness game • But a single game could not fit with requirements we identified • Identified requirements and architecture – a suite of games would be needed, along with a central framework – a gamification framework (edufitment) would be needed to provide extensibility, security, privacy, and internationalization • Developed a gamification framework, suite of games, plugin game API, and meta game to meet our requirements – Games track user progress through metrics (game statistics) – All games connect to framework through plugin game API – Earned coins are spent in meta game – Leaderboards are shown prominently alongside game statistics and logged in user progress • Provided an analysis of how well the framework and games fit the original objective and requirements set forth Conclusions – Thesis Contributions

• Provides the development of a structured, secure, multilingual, and expandable healthcare gamification framework that can be used to build nutrition and fitness knowledge in elementary school children, with the potential to teach or modify their behavior. • Provides a path for developing suites of games that have the potential to improve nutrition and fitness in children • Provides a methodology and architecture for gamifying work and curriculum development that could also be applied in other domains Conclusions - Future Work • Improve current alpha games and framework; then deploy, test, and release to the public • Add additional mini- and meta- games • Introduce automatic game statistics – Current flexible game statistics makes adding new games complicated for the Administrators (but not to game developers) • Improve current game mechanics – Dashboard would provide clearer view of player progress if game statistics appeared alongside point accumulation – Experience points could be used in conjunction with player levels to unlock new games – Leaderboards could be improved to place player in the middle, seeing how far they are from the person above them • Add more game mechanics – Levels for unlocking additional games, providing SAPS access reward – Badges awarded for accomplishing achievements in each game to entice users to continue playing – Quests and social engagement loop if framework were released to the public Conclusions - Future Work

• Improve Security – Prevent brute force game API logins by locking out games after a few invalid attempts – Prevent high level access by requiring a password to be re-entered each time a form is submitted by a high-ranking user – Enable users to contact Administrators when malicious games are found or if account has been compromised • Administrators can reset passwords • Expand to more age groups – Provide a different set of games – Prevent older age groups from chatting with minors – Separate leaderboards by age groups • Other additions – Additional coin types – Re-purpose the framework to teach curriculum other than nutrition and fitness – Tackle other serious issues Bonus Level - Integration Frameworks

• Many healthcare monitors exist today – Fitbit, Bioharness, Nike+ Fuelband, etc. • Most of them are highly encapsulated – Many are closed and do not provide an API • Medical providers may be subject to security and privacy rules (HIPAA – 1996) • Other monitors may not want to share data – Even if an API is provided, connecting to each API requires a different set of functions and technologies • Useful for consumers to overlap data between healthcare monitors – High weight gain might indicate high sodium levels which might mean congestive heart disease • If each monitor is encapsulated, computers cannot come to this conclusion • Growing need to integrate multiple frameworks to obtain a more complete picture of a user's data – Quantitative Self movement is growing in popularity • Term to describe tracking all aspects of life (weight, glucose, mood, blood pressure, sleep patterns but also finances, travel, …) • Future of frameworks lies in the ability to easily combine data from various frameworks – Integration frameworks provide a common website for a variety of data feeds • These take advantage of device APIs by providing a central framework that plugs in monitoring APIs – Several home health monitoring solutions have attempted to incorporate this method • There are currently no standards for how to do this • Thus, there are competing models, meaning these solutions would also be encapsulated – SCORM (Sharable Content Object Reference Model) provides a standard method of communicating between e-learning applications • Industry standard for e-learning software; used by many universities; Blackboard also uses SCORM – To facilitate the future of frameworks, integration frameworks, standard methods of inter-framework communication need to be developed Questions?