MEDINFO 2017: Precision Healthcare through Informatics 183 A.V. Gundlapalli et al. (Eds.) © 2017 International Medical Informatics Association (IMIA) and IOS Press. This article is published online with Open Access by IOS Press and distributed under the terms of the Creative Commons Attribution Non-Commercial License 4.0 (CC BY-NC 4.0). doi:10.3233/978-1-61499-830-3-183 An Exploratory Analysis of Game Telemetry from a Pediatric mHealth Intervention Rema Padmana, Disha Guptaa, Bhargav Sri Prakashb, Chelladurai Krishnanb, K. Panchatcharamb a The H. John Heinz III College, Carnegie Mellon University, Pittsburgh, PA, USA, b FriendsLearn, Chennai, India Abstract Pediatric obesity is a growing epidemic, with unhealthy eating Background habits and poor physical activity being major contributors. While video and mobile games have been shown to have a Pediatric Obesity positive impact on behavior change in children, the Obesity is an increasingly common epidemic in children. The mechanisms underlying game play that impact outcomes of growing pediatric obesity rate worldwide has serious health interest are poorly understood. This research aims to examine consequences such as cancers, diabetes, asthma and shortened the impact of a novel mobile gaming app on the design of life span as well as higher healthcare costs [1; 2; 6]. While there behavioral interventions by learning from the rich and unique are many factors that contribute to overweight and obesity, diet game telemetry generated from a randomized controlled trial decisions are a leading cause [1]. Unhealthy eating habits and of the app use by school children. In this exploratory analysis, poor physical activity is a major contributor to the growing we extract a partial dataset to build and analyze chronological obesity epidemic [7]. There is significant ongoing focus on sequences of game plays to understand key patterns in the game addressing the risk factors and moving the population to a mechanics that players utilize as they navigate the game, and healthier lifestyle through health education/ communication possible implications of the results. and motivation. Establishing healthy eating habits early in life Keywords: is important because childhood habits are predictive of those in Pediatric Obesity; Mobile Apps; Game Telemetry Analysis adulthood [7]. There is a clear need to identify effective methods for improving dietary intake and physical activity Introduction habits earlier in life that are acceptable to children. Games on Mobile Devices This research is motivated by the need to explore some of the Games have been shown to have positive impact on children challenges and related opportunities at the intersection of the [8]. Many children spend several hours a day playing video rising epidemic of pediatric obesity worldwide [1], healthy games [3; 4], mostly on mobile devices, a platform through eating and physical activity related behavior modification which they can learn about health in a fun and enjoyable way. challenges in children [2], and the growing role of gamification This may be one approach to address the multi-faceted and learnification on mobile devices in the lives of these challenge of the pediatric overweight and obesity epidemic [9, pediatric digital natives [3]. While there is some early evidence 10]. of the positive impact of video games on healthy eating behaviors in children [4], the mechanisms underlying these However, a critical barrier to progress in the field is the lack of improved outcomes are yet to be understood. To design understanding about the mechanisms underlying games that appropriate interventions in the game environment for impact outcomes of interest. Video games include many levels children’s behavior formation and change, we need to learn of challenges, imaginative virtual worlds, and the opportunity more about the underlying patterns of player behaviors to navigate them in distinct ways, alone or in teams [11]. The evidenced during gameplay, the goals they are trying to achieve appeal of discovery may be a strong motivator of these games with the game, and their overall gameplay experiences. to some players while others may enjoy the competitive or collaborative nature of the game. Gamification is the studied, thoughtful, and creative application of game design elements to In this exploratory study, we analyze game telemetry to engage the player [11; 12]. Games with a highly directed understand user interactions from playing Fooya, an experience and tiered set of tasks can challenge and motivate iOS/Android based mobile App that has been shown to improve players. While much is known about game design, recent the nutrition-health of children through virtual reality-based research has highlighted the gap in understanding the specific immersive mobile gaming which uses Artificial Intelligence to mechanisms that link the game playing behaviors with observed achieve personalized behavior reinforcement [5]. We analyze outcomes so that game design as well as re-design can be the interactions with the game choices made by the players in a informed through evidence based knowledge and practices [12- randomized controlled experiment in a middle school setting. 14]. Learning from and associating game playing behaviors with known factors affecting unhealthy eating behaviors and the Game Telemetry players’ food choices at the end of the game may provide new Large volumes of data are routinely collected during game play insights into the complex interactions between game playing and analyzed in simple ways. Game developers nowadays and health behavior changes necessary to design more remotely and unobtrusively monitor every aspect of a game, impactful interventions via games on mobile devices in order to allowing them to accumulate large amounts of data of the improve pediatric overweight and obesity rates. player-game interaction over extended time periods [15]. One type of data collected is the actual clicks made by the player as 184 R. Padman et al. / An Exploratory Analysis of Game Telemetry from a Pediatric mHealth Intervention they navigate the game, called game telemetry. At the current during randomized-controlled clinical trials conducted at the time, this clickstream data is used to analyze questions such as Baylor College of Medicine’s Children’s Nutrition Research whether players are entering the game or not, if they are Center [5]. Researchers at Kaiser Permanente Medical Group dropping out early or late, if they are playing the game for a were involved in analyzing longitudinal impact on over 1000 while and then dropping out at some distinct step, and so on. children at multiple sites over a weeklong period during the This type of feedback is made available in real time so that ExxonMobil Summer Science Camp [18]. These findings are game developers can track usage and player engagement that significant as increasing awareness and self-efficacy are the have implications for success of the game. first steps to achieving health behavior change [19]. Outcomes from these and other trials have shown consistently positive Learning from clickstream/telemetry data. trends, while also exposing opportunities for product feature development, enhancement and continuous refinement. This novel approach to behavior design aims to pave the way for This data is a valuable source for developers and game targeting lifestyle disease prevention by enabling lifelong designers to guide decision-making throughout the game design healthy lifestyle habits. This may be achieved by instilling process, to understand player movements, reduce production healthier preferences during early childhood and the formative costs, or uncover bugs, among others. At the same time, the years of life. increasing popularity of online gaming has led to in-game statistics to improve player experiences by providing performance summaries and comparisons to others playing the Through game design that achieves a psychological state of game. There is now a growing field of game analytics, some of flow for deep cognitive engagement, fooya!TM aims to increase it focused on using telemetry data to discover and communicate awareness and induce greater self-efficacy. Underlying health meaningful patterns in data in the context of game development models enable story telling surrounding topics of metabolic and game impact [15]. For example, identifying which paths equilibrium and health balance pertaining to the user’s Avatar. result in the longest game time and what game features engage fooya!TM harnesses multiple core game mechanisms that players in these paths require methods to learn paths from the deliver a single player and multiplayer experience to achieve detailed telemetry data and then examine the features that behavior design through a social, mixed reality experience. define these paths in unique ways. Hence new approaches that Game compulsion loops guide users while getting harder over leverage advanced statistical machine learning methods that time, which makes users think more deeply and strategically, can learn from large volumes of multiple streams of high the more they play. The core engagement mechanism in dimensional data have the potential to facilitate the analysis of fooya!TM adaptively engineers user experience moments that patterns in telemetry data streams. deliver a highly contextual message through a method of experiential discovery, as the result of learnification – a design thinking method of embedding and harnessing contextual Impact on design of behavioral