Open access peer-reviewed chapter
Abstract
After the CoVid-19 pandemic lockdown occurred (2020–2021), there have been crucial changes in teaching-learning methodologies, mainly because of the emergency online education format, due to the high demand for online education formats. Long hours of learning in front of a screen besides the stressful environment surrounding the pandemic make it difficult to keep learning motivation high, which shows the need for an urgent change in instructional design. This change includes using interactive and participative methodologies for tackling the anxiety produced by the global health crisis. In this frame, gamification tools have emerged worldwide entailing significant benefits to education. Nevertheless, the overuse of technology can lead to several problems including physiological complications among other things, myopia, diabetes, and coronary disease risk (because of sedentariness) and even addiction. Finally, research proves that an adequate frame around technology use and games inclusion in learning can help diminish or even avoid social problems such as addiction and the resulting concentration problems. Furthermore, in the case of active video gaming, it might be advisable for alleviating sedentary habit-related diseases. Therefore, it is important to reflect on the use of games and its objectives for obtaining the best results from powerful strategic motivators.
Keywords
- motivation
- gamification
- CoVid-19
- learning methodology
- online teaching
1. Introduction
Several factors have caused changes in education in the last few years. CoVid-19 pandemic has been the reason for important changes in education, forcing an urgent shift to virtual education as never before. The resulting lockdown entailed, among other consequences, a significant increase in loneliness and, as a result, stress-related behaviors and cognition [1]. Beyond these serious facts, students have been exposed to additional stressors including economy-related challenges such as access to technology and learning conditions [2]. These last ones include user-unfriendly requirements of online education, under-stimulation, low perceived control over tasks [3], reduced learning time, and inadequate methodological design for online teaching, among others [4]. In such a frame, gamification played an important role in improving educational design. Gamification is not entirely new since the term was already minted by game designer Nick Pelling in 2002, with a later ubiquitous interest in the 2010s. The definition is then applied to “the use of game-based elements in nongame contexts to encourage users to perform desired behavior” [5] (p. 158).
Results have shown that gamification is a motivational, innovative, and engaging strategy for teaching learning not only in one but also in several different areas [6] even if the conditions of the pandemic lead to burnout [7] and anxiety [8].
When speaking about management, [9] mentions several reasons for resistance to change. These reasons include not understanding the objectives of such a change, disagreement with the new directions of enterprises, or merely anxiety about the consequences of change in their jobs. These considerations can help to understand why teachers had not massively included gamification in instructional design before the pandemic. Nevertheless, several arguments prove that gamification can considerably improve learning quality and students’ motivation.
Supporting this last argument, there are a number of articles verifying the effectiveness of serious games as learning instruments for understanding scientific conceptions since they have been related to positive performances in the field [10]. As a key aspect of design, challenging content is advised as well as recognition of content-related benefits [11].
Nonetheless, there are serious objections worth considering. Such objections are related to game addiction [12, 13, 14, 15, 16] and underline the importance of balance since even the best tools can have little or no impact when not framed in the right design. Together with these objections, video games are currently linked to sedentariness and consequently to obesity and other negative health conditions, with the exception of active video games [17].
2. A never-seen-before scenario: CoVid-19 pandemic
The World Health Organization (WHO) declared the Coronavirus disease (CoVid-19) on March 11, 2020, with more than 47 million confirmed cases by the end of April 2021. Even if Ecuador was not one of the countries with the highest number of confirmed cases, it was severely impacted. Still more, besides the impact on the health system, socioeconomic, equity, and ethical dimensions were reported [18].
Because of the aforementioned pandemic, several mobility restrictions were implemented worldwide, and our country was not the exception. As a result, a worse self-reported mental health was verified, which led to the recommendation of health promotion measures to mitigate the effects of confinement on mental health, particularly in youngsters and women, the most touched populations according to research [19].
As another consequence of this confinement, economic activities were affected. For instance, the tourist sector—an important source of revenue in Ecuador—reported falling occupancy rates, reduced pay, mass layoffs, and shutdown [20]. Research has found that pandemic stress is directly related to ill family members and kids involved in online learning [21].
Naturally, the pandemic itself had an impact on the population’s mental health, specifically through a high level of distress as a direct consequence of news [22] not to mention domestic violence and multiple domains of abuse needing adequate prevention problems [23].
In this complex context, adequate methodologies, frameworks, and tools have been used to overcome education affectation since everyday learning should not be interrupted. Then, the educational process would be allowed to continue at their regular pace, reflecting even an improved performance and a positive mindset. According to this research, the CoVid-19 pandemic scenario indirectly contributed to taking advantage of the huge amount of courses, video lectures, learning tips, and mentoring material available through online tools for a more efficient learning process. At the same time, people’s productivity and usefulness increased as an additional consequence [24].
3. Novelty
When analyzing the efficacy of gamification, the first argument is novelty since neuroscientific research shows how it plays a role in dopamine production. According to the studies, dopamine production is linked to motivational aspects and could lead to consolidation in long-term memory [25]. Additionally, novelty seeking—closely related to increased exploratory activity and intense excitement in response to novelty and active avoidance of monotony and frustration—is also associated with variation in dopamine levels [26]. This argument is backed by additional research, where novelty and surprise are placed among the most important primary factors of interest, exploratory or avoidance behaviors, and learning [27].
Exploring other contexts, biological causes of intelligence of memory problems have been linked to genetic origins. Particularly dealing with novelty seeking but also to predisposition to higher education, academic achievement, nature of peer relations, and behavioral problems lying behind school dropping [26].
Novel exploration is defined as a fundamental adaptation mechanism. Novelty impacts reward processing and consequently decision-making and operant conditioning. Their research analyzes the role of novelty in reward-based learning. They claim that novel stimuli have an impact on learning speed and additionally, the extent of such effect is linked to behavior and personality [28].
Considering a different point of view, novelty detection and novelty processing have been scoured back to the hippocampus and the amygdala, which lead to weighing the role of brain health on the learning process [29].
4. Gamification and motivation
Identifying Motivation-Related Strategies for the linked elements (performance significance, mastery orientation, interest, self-respect, among others) for creating adequate recommendations will significantly contribute to scaffolding students’ self-regulation as well as their motivation to learn [30]. In the context of the CoVid-19 Pandemic, the use of strategies for raising motivation responded to an intuitive attempt to improves learning conditions. The theoretical support for such measures comes with the recommendations of increasing students’ satisfaction with online classes and preserving their mental health [31].
Some related studies show how games use themselves is not a solution for increasing motivation. Cultural and situational factors play a role in games’ effectiveness [32] along with voluntary participation, which significantly increases motivation although the use of games is appreciated even if participation is not voluntary [33] although other studies mention a correlation with improved academic performance even when participation is not voluntary [34]. Anyway, the inclusion of games would have a positive effect on intrinsic need satisfaction [35].
Significant increase in motivation when using gamification has been found (specifically, when using the Kahoot application), even with some limitations with regard to the sample profile and the course topic, something observed in more than half the population [36]. Students have also reported strengthening in the interactive nature of the classes and even faster knowledge absorption due to game inclusion [37].
Similarly, to the use of these applications, the implementation of points, badges, and leaderboards, used to include gamification in the classroom, is reported to increase motivation and active participation by means of positive competition. For instance, Quiz games and similar techniques as mentioned as a usual component of learning settings [38]. An additional advantage is the acknowledgment of individual achievements. Hence, the use of gamification elements in a traditional class would strengthen students’ motivation and for increasing their participation consequently improving the quality of the learning and the productivity of the entire process [39].
As proof of the efficiency of electronic video games, it is reported their impact is even a complement to physical pain relief. In this sense, the findings are associated with a psychosocial model of pain in patients undergoing cancer treatment [40].
5. Serious game and learning
The ability of video games to raise engagement, motivation, and challenge has entailed both teachers and psychologists to search to design games for entertainment, of course, but also for educating [41]. Pursuing such a goal, several different models have been developed.
Among these models is Digital Games-Based Learning (DGBL) where a conscious selection of the game will be done for further completion of the lacking content. This selection should consider breadth in content but also depth. Additionally, it is important to analyze who would provide this additional content and why. A final consideration is mentioned: Even with the advantages of Digital Games for raising motivation, commitment, and participation, is it worth the huge amount of work for analyzing the suitable game, designing a complete framework, and completing its content for providing an effective learning tool [42]?
Furthermore, related research argues that serious games have exploited a limited set of game elements (e.g., badges, points, and leaderboards), suggests going deeper, and exploring the use of arcade features, reporting to be more engaging than traditional approaches. The use of arcade game elements significantly increased knowledge about correct behaviors [43].
In the same way, serious games have been proven to be an efficient mechanism for making technology users more aware of their vulnerability to cyber-attacks with an increase in understanding and knowledge [44]. This aspect might not be directly related to learning outcomes but is definitely important for improving technology-related behavior.
Finally, serious games’ more complex nature comes from their aim to plan instructional elements for a fun, engaging, and educational experience besides maintaining control of the several elements for a fun game as any other entertainment game. Therefore, this complex learning tool can indeed contribute to increasing self-efficacy by showing players their ability to succeed [45].
6. Cooperation, emotional competencies, and gamification
The challenges of current society need people to develop specific skills in order to be functional individuals. Current scientific evidence partially explains mental disorders in terms of a lack of cooperation-related skills and the inability to be aware of the position of others [46]. At the same time, current social challenges become important stressors and can eventually trigger anxiety disorders, obsessive-compulsive disorders, and trauma and stressor-related disorders, which could eventually benefit from better thought processing and/or improved human interpersonal relationships according to [47]. In order to get such interpersonal improvement, relationships of self-awareness, self-regulation empathy, and social skills might play a role as they actually do on academic performance in the context of cooperative learning [48].
Video games are reported to foster highly necessary skills related to both collaborative learning and strategic thinking. The feature of video games’ design requiring players to collaborate and communicate with each other for progressing is a powerful exercise to strengthen collaborative skills and problem-solving even when there is no educational aim [49]. In the same way, when dealing with professional development in a wider context, gamification inclusion in training has been reported to have an impact on cooperation, autonomy, and personalization [50].
As another example of the usefulness of games in education, Game Object Model (GOM) has been developed and, even if the challenging technical conception and complexity of design are admitted, so are their ability to facilitate conceptualization and assessment [51].
7. Games and physical health
Physical literacy (a certain degree of fitness, behaviors, knowledge, and skill related to physical activity) can undoubtedly be affected by the game practice. Some research concludes that the degree of physical activity can indeed play an important role when dealing with important diseases such as coronary heart disease, type 2 diabetes, and breast and colon cancers. In this way, compared with other factors of poor health, physical inactivity and smoking or obesity would have a similar impact [52]. Besides, sedentary activities during adolescence have been correlated with suicidal behavior [53].
Quotidian activities nowadays include video gaming, which is mainly associated with sedentariness. This way, video game practice becomes a problem because of obvious consequences and links to eyestrain, myopia, obesity, and related diseases, which can already be tackled by several advised interventions for improving people’s health, particularly for children and adolescents [54]. The aforementioned vision complications got increased by extended computer or digital device use, resulting from digital reading during virtual classes [55].
It is important to emphasize that gamification is not implicitly depending on the use of screens. New development in technology has also explored audio interaction and content that can be transferred through intelligent virtual assistants (IVAs) with considerable advantages since they are mainly independent to screen use even if in some cases they can be complementary to augmented reality technologies [56].
Even if video gaming is not exactly the same as television watching, in terms of sedentariness, they are virtually very close. Considering this fact, important research finding an increased risk for low bone mineral content in male adolescents who watched television more than 3 hours per day [57] acquires even more importance since now, both of the activities contribute to increasing negative health effects.
Specifically dealing with non-transmissible diseases such as coronary heart disease and diabetes, important recommendations point to physical activities’ regular practice in order to decrease the incident rates [58]. Besides, after surgical revascularization, remaining high rates of low-density cholesterol and low rates of high-density cholesterol are associated with long-term cardiac death [59].
Focusing on another scope, overexposure to screens can in fact have a serious impact on young children. Emotional problems, anxious/depressive symptoms, somatic complaints, social withdrawal symptoms, attention problems, and aggressive behaviors have been reported in young children spending more time on touch screen devices [60].
In a more serious context, suicidal ideation is mentioned to come to fruition into actual attempts within a year, which highlights the importance of addressing poor physical activity, since it is a factor for more likely suicidal ideation [53].
As alternatives, sports video gaming and active game practice come on stage. Sports video gaming support on physical activity has been highlighted based on similar domains of activity even if the awareness of physical activity importance has not been verified [61]. What is more, active game practice, active virtual reality games specifically, has been reported to provoke moderate-to-vigorous physical activity without increases of motion sickness [62] even if in some cases experts have advised cardiac patients against its practice, due to important demands on anaerobic metabolism [63].
8. The importance of instructional design
Research has revealed gamification is not effective per se. Its success would instead be linked to the effective design of gamified interventions, mainly including serious games and game-based learning. There is then, an increasing number of literature analyzing the theoretical foundations behind gamification in a number of contexts, mainly considering motivation, behavior, and learning theories. This literature deals with fragmented context albeit a synthesis of them may lead to a portrayal of basic principles for gamification design [64].
Gamification design’s most effective elements then include competitive game elements and digital feedback. This way, constructive implementation of gamification is proven to lead to high-order skills development [50]. Additional research has also stood up the fact of game elements such as rewards, competition level, and other related elements do not automatically raise engagement and motivation. In lieu, psychological theories need to be involved in granting quality outcomes. Among these theories, self-determination and goal-setting theory would be outlined together with a user-centered design perspective [5].
Combining all these elements, suitable teaching training not only in gamification but also in other trendy methodologies such as flipped classroom, adaptive learning, inquiry-based learning, and more will allow the implementation of multiple digital pedagogies in an interdisciplinary approach aiming to make things easier for granting the students comfort ensuring this way their engagement in the learning process [65].
Beyond educational research, gamification design is even reaching the manufacturing sector because of its high success rates, which has been replicated even if such replication is not yet clearly explained by the use of gamification as a technique or as a new and novel tool [66].
9. Game-related addictions
It is also important to mention the serious implications linked to the abuse of games. Research has shown Internet Addiction Disorder, Internet Gaming Disorder, and Mobile Phone Addiction in children as well as some evidence linking it to Attention Deficit Hyperactivity Disorder [12].
Along the same line, several types of behaviors and impulse control disorders have been already mentioned [13]. Among them, the most closely related to game addiction would be cyber-relationship addictions, when online relationships are the focus of the disorder; net compulsions, when the addiction is about online gambling or shopping online, and computer addiction, when the disorder is about obsessive game playing properly called. Nevertheless, as [14] highlights, addiction to the Internet happens when individuals are involved in an alternative reality allowed by the Internet. This fact should be distinguished from other behaviors that might not be directly related to the Internet since the behavior could happen in other conditions/places and not exclusively on the Internet.
When analyzing academic performance, excessive internet use has been reported as a cause of school burnout [15] even before the CoVid-19 pandemic when the use of technology was exponentially increased because of the lockdown.
From the interpersonal point of view, relationships between parents and their teens play a decisive role in Problematic Internet Use, and they can significantly contribute either to reducing or increasing PIU [16, 67].
Additionally, there are scientific evidence of Internet addiction, compulsive computer use, and video game excessive use associated with subjective distress, functional impairment, and other psychiatric disorders [68]. This scientific evidence has led even to the inclusion of both gambling disorder and gaming disorder into the ICD-11 (Internet Classification of Diseases – World Health Organization), which confirms the urgency of analysis of these behaviors.
Fortunately, these preoccupations have not gone unnoticed as shown by several attempts to identify and explain Internet addiction and similar behaviors (e.g., the Internet Addiction Test, whose validity has been researched by [69]; the Adolescent Pathological Internet Use Scale, researched by [70]; the Chinese Internet Addiction Scale, [71]; and the Compulsive Internet Use Scale, [72], among others).
10. Conclusions
Changes in society involving increasing exposure to screens, media, and video games support the election of gamification for improving learning outcomes. These changes were exponentially increased by CoVid-19 Pandemic Lockdown. Motivation levels, autonomy, and academic outcomes can significantly benefit from this innovation. Nevertheless, this is not an option that could be taken lightly, evidence of the growing number of disorders related to the abuse of technology and games highlights the importance of the appropriate design and guidance in order to lead to the best result and avoid negative effects such as impact on health and propensity to addictions.
Acknowledgments
The authors would like to thank Mauro Ocaña, The Department of Human and Social Sciences at Armed Forces University, and Armed Forces University.
Conflict of interest
The authors declare no conflict of interest.
References
- 1.
Haucke M, Heinz A, Liu S, Heinzel S. The impact of COVID-19 lockdown on daily activities, cognitions, and stress in a lonely and distressed population: Temporal dynamic network analysis. Journal of Medical Internet Research. 2022; 24 (3):e32598 - 2.
Tao J, Gao X. Teaching and learning languages online: Challenges and responses. System. 2022; 107 :102819 - 3.
Yazdanmehr E, Elahi Shirvan M, Saghafi K. A process tracing study of the dynamic patterns of boredom in an online L3 course of German during COVID-19 pandemic. Foreign Language Annals. 2021; 54 (3):714-739 - 4.
Sahu P. Closure of universities due to Coronavirus disease 2019 (COVID-19): Impact on education and mental health of students and academic staff. Cureus. 2020; 12 (4):e7541 - 5.
Patricio R, Moreira AC, Zurlo F. Gamification in innovation teams. International Journal of Innovative Studies. 2022; 6 (3):156-168 - 6.
Nieto-Escamez FA, Roldán-Tapia MD. Gamification as online teaching strategy during COVID-19: A mini-review. Frontiers in Psychology. 2021; 12 :648552 - 7.
Moreno-Fernandez J, Ochoa JJ, Lopez-Aliaga I, Alferez MJM, Gomez-Guzman M, Lopez-Ortega S, et al. Lockdown, emotional intelligence, academic engagement and burnout in Pharmacy students during the quarantine. Pharmacy (Basel) [Internet]. 2020; 8 (4):194 - 8.
Khoshaim HB, Al-Sukayt A, Chinna K, Nurunnabi M, Sundarasen S, Kamaludin K, et al. Anxiety level of university students during COVID-19 in Saudi Arabia. Frontiers in Psychiatry. 2020; 11 :579750 - 9.
Gotsill G, Natchez M. From resistance to acceptance: How to implement change management. Training and development. 2007; 61 (11):24-27 - 10.
Zhonggen Y. A meta-analysis of use of serious games in education over a decade. International Journal of Computer Games Technology. 2019; 2019 :1-8 - 11.
Platz L. Learning with serious games in economics education a systematic review of the effectiveness of game-based learning in upper secondary and higher education. International Journal of Educational Research. 2022; 115 (102031):102031 - 12.
Menéndez-García A, Jiménez-Arroyo A, Rodrigo-Yanguas M, Marin-Vila M, Sánchez-Sánchez F, Roman-Riechmann E, et al. Adicción a Internet, videojuegos y teléfonos móviles en niños y adolescentes: Un estudio de casos y controles. Adicciones. 2022; 34 (3):208-217 - 13.
Young KS. Internet addiction: Evaluation and treatment. BMJ. 1999; 319 (Suppl S4):9910351 - 14.
Griffiths M. Internet addiction - Time to be taken seriously? Addictive Research. 2000; 8 (5):413-418 - 15.
Salmela-Aro K, Upadyaya K, Hakkarainen K, Lonka K, Alho K. The dark side of internet use: Two longitudinal studies of excessive internet use, depressive symptoms, school burnout and engagement among Finnish early and late adolescents. Journal of Youth and Adolescence. 2017; 46 (2):343-357 - 16.
Bleakley A, Ellithorpe M, Romer D. The role of parents in problematic internet use among US adolescents. Media and Communication. 2016; 4 (3):24-34 - 17.
George AM, Rohr LE, Byrne J. Impact of Nintendo Wii games on physical literacy in children: Motor skills, physical fitness, activity behaviors, and knowledge. Sports. 2016; 4 (1) - 18.
Alava JJ, Guevara A. A critical narrative of Ecuador’s preparedness and response to the COVID-19 pandemic. Public Health Practise. 2021; 2 :100127 - 19.
Carpio-Arias TV, Piedra-Andrade JS, Nicolalde-Cifuentes TM, Padilla-Samaniego MV, Tapia-Veloz EC, Vinueza-Veloz MF. Mobility restrictions and mental health among young adults during the COVID-19 pandemic in Ecuador. Gaceta Sanitaria. 2022; 36 (6):512-519 - 20.
Alotaibi E, Khan A. Impact of Covid-19 on the hospitality industry and responding to future pandemic through technological innovation. Procedia Computer Science. 2022; 204 :844-853 - 21.
Rosen CS, Kaplan AN, Nelson DB, La Bash H, Chard KM, Eftekhari A, et al. Implementation context and burnout among Department of Veterans Affairs psychotherapists prior to and during the COVID-19 pandemic. Journal of Affect Disorders. 2022; 320 :517-524 - 22.
Calegaro VC, Ramos-Lima LF, Hoffmann MS, Zoratto G, Kerber N, Costa FCD, et al. Closed doors: Predictors of stress, anxiety, depression, and PTSD during the onset of COVID-19 pandemic in Brazil. Journal of Affect Disorders. 2022; 310 :441-451 - 23.
Mazza M, Marano G, Lai C, Janiri L, Sani G. Danger in danger: Interpersonal violence during COVID-19 quarantine. Psychiatry Research. 2020; 289 :113046 - 24.
Affouneh S, Burgos D. A 6-key action plan for education in times of crises. In: Lecture Notes in Educational Technology. Singapore: Springer Singapore; 2021. pp. 11-21 - 25.
Düzel E, Bunzeck N, Guitart-Masip M, Düzel S. NOvelty-related motivation of anticipation and exploration by dopamine (NOMAD): Implications for healthy aging. Neuroscience and Biobehavioral Reviews. 2010; 34 (5):660-669 - 26.
Keltikangas-Järvinen L, Elovainio M, Kivimäki M, Ekelund J, Peltonen L. Novelty seeking as a mediator in relationships between type 4 dopamine receptor gene polymorphism and predisposition to higher education. Learning and Individual Differences. 2003; 14 (1):23-30 - 27.
Barto A, Mirolli M, Baldassarre G. Novelty or surprise? Frontiers in Psychology. 2013; 4 :907 - 28.
Houillon A, Lorenz RC, Böhmer W, Rapp MA, Heinz A, Gallinat J, et al. The effect of novelty on reinforcement learning. Progress in Brain Research. 2013; 202 :415-439 - 29.
Schomaker J, Grouls MME, van der Linden CGM, Rau EM, Hendriks M, Colon A, et al. Novelty processing depends on medial temporal lobe structures. Neurobiology of Learning and Memory. 2021; 183 (107464):107464 - 30.
Ilishkina DI, de Bruin A, Podolskiy AI, Volk MI, van Merriënboer JJG. Understanding self-regulated learning through the lens of motivation: Motivational regulation strategies vary with students’ motives. International Journal of Educational Research. 2022; 113 (101956):101956 - 31.
Kapasia N, Paul P, Roy A, Das P, Ghosh T, Chouhan P. Perceived academic satisfaction level, psychological stress and academic risk among Indian students amidst COVID-19 pandemic. Heliyon. 2022; 8 (5):e09440 - 32.
van Roy R, Zaman B. Unravelling the ambivalent motivational power of gamification: A basic psychological needs perspective. International Journal of Human Computer Studies. 2019; 127 :38-50 - 33.
Frost RD, Matta V, Macivor E. Assessing the efficacy of incorporating game dynamics in a Learning Management System. 2022 - 34.
Narváez Carrión CR, Larrea Astudillo NC, Cruz Báez EC, Analuisa MJ. Análisis empírico sobre el rendimiento académico de los estudiantes en la asignatura de inglés con el uso de Voscreen. Educare. 2021; 25 (1):240-258 - 35.
Xi N, Hamari J. Does gamification satisfy needs? A study on the relationship between gamification features and intrinsic need satisfaction. International Journal of Information Management. 2019; 46 :210-221 - 36.
Yildiz İ, Topçu E, Kaymakci S. The effect of gamification on motivation in the education of pre-service social studies teachers. Thinking Skills and Creativity. 2021; 42 (100907):100907 - 37.
Tang H-HH, Dang BYY, Raby RL, Yeung JWY. Sustaining liberal education by online learning in the era of global crises. In: Online Teaching and Learning in Higher Education during COVID-19. New York: Routledge; 2021. pp. 181-198 - 38.
Sandrone S, Carlson C. Gamification and game-based education in neurology and neuroscience: Applications, challenges, and opportunities. Brain Disorders. 2021; 1 (100008):100008 - 39.
Xu J, Lio A, Dhaliwal H, Andrei S, Balakrishnan S, Nagani U, et al. Psychological interventions of virtual gamification within academic intrinsic motivation: A systematic review. Journal of Affected Disorders [Internet]. 2021; 293 :444-465 - 40.
Alonso Puig M, Alonso-Prieto M, Miró J, Torres-Luna R, López P, de Sabando D, et al. Authorship correction: The association between pain relief using video games and an increase in vagal tone in children with cancer: Analytic observational study with a quasi-experimental pre/posttest methodology. Journal of Medical Internet Research. 2020; 22 (7):e19961 - 41.
Starks K. Cognitive behavioral game design: A unified model for designing serious games. Frontiers in Psychology. 2014; 5 :28 - 42.
Van Eck R. Digital game-based learning: It’s not just the digital natives who are restless. Educause Review. 2006; 17 :16-30 - 43.
Chittaro L, Buttussi F. Exploring the use of arcade game elements for attitude change: Two studies in the aviation safety domain. International Journal of Human Computer Studies. 2019; 127 :112-123 - 44.
Baral G, Arachchilage NAG. Building confidence not to be phished through a gamified approach: Conceptualising user’s self-efficacy in phishing threat avoidance behaviour. In: 2019 Cybersecurity and Cyberforensics Conference (CCC). Melbourne: IEEE; 2019 - 45.
Blasko-Drabik H, Blasko DG, Lum HC, Erdem B, Ohashi M. Investigating the impact of self-efficacy in learning disaster strategies in an on-line serious game. Proceedings of the Human Factors and Ergonomics Society. 2013; 57 (1):1455-1459 - 46.
Ollinheimo A, Hakkarainen K. Critical thinking as cooperation and its relation to mental health and social welfare. New Ideas Psychology. 2023; 68 (100988):100988 - 47.
Sloover M, van Est LAC, Janssen PGJ, Hilbink M, van Ee E. A meta-analysis of mentalizing in anxiety disorders, obsessive-compulsive and related disorders, and trauma and stressor related disorders. Journal of Anxiety Disorders. 2022; 92 (102641):102641 - 48.
Fernandez-Perez V, Martin-Rojas R. Emotional competencies as drivers of management students’ academic performance: The moderating effects of cooperative learning. International Journal of Management Education. 2022; 20 (1):100600 - 49.
Barr M. Graduate Skills and Game-based Learning: Using Video Games for Employability in Higher Education. 1st ed. Cham, Switzerland: Springer Nature; 2020 - 50.
Cechella F, Abbad G, Wagner R. Leveraging learning with gamification: An experimental case study with bank managers. Computers in Human Behavior Reports. 2021; 3 (100044):100044 - 51.
Amory A. Game object model version II: A theoretical framework for educational game development. Educational Technology Research and Development. 2007; 55 (1):51-77 - 52.
Lee I-M, Shiroma EJ, Lobelo F, Puska P, Blair SN, Katzmarzyk PT, et al. Effect of physical inactivity on major non-communicable diseases worldwide: An analysis of burden of disease and life expectancy. Lancet. 2012; 380 (9838):219-229 - 53.
Silva AF, Junior CA, de Hinnig P, de Lima LR, Silva DA. Suicidal behaviors and sedentary lifestyles among adolescents: A cross-sectional epidemiological study in Latin American and Caribbean countries. Clinics. 2020; 75 :e2015 - 54.
Narváez Carrión CR, Larrea Astudillo NC, Cruz Baez E, Analuisa Maiguashca J, Córdova E. ¿Papel o pantalla? Preferencias de los estudiantes en lo referente a la lectura. Revista Vínculos ESPE. 2022; 7 (2):45-59 - 55.
Ng K, Kaskinen A-P, Katila R, Koski P, Karhulahti V-M. Associations between sports videogames and physical activity in children. Physical Culture and Sport Studies Research. 2022; 95 (1):68-75 - 56.
Bräuer P, Mazarakis A. “Alexa, can we design gamification without a screen?” - Implementing cooperative and competitive audio-gamification for intelligent virtual assistants. Computer Human Behavior. 2022; 135 (107362):107362 - 57.
Sousa CV, Hwang J, Cabrera-Perez R, Fernandez A, Misawa A, Newhook K, et al. Active video games in fully immersive virtual reality elicit moderate-to-vigorous physical activity and improve cognitive performance in sedentary college students. Journal of Sport and Health Science. 2022; 11 (2):164-171 - 58.
Pardhan S, Parkin J, Trott M, Driscoll R. Risks of digital screen time and recommendations for mitigating adverse outcomes in children and adolescents. The Journal of School Health. 2022; 92 (8):765-773 - 59.
Vicente-Rodríguez G, Ortega FB, Rey-López JP, España-Romero V, Blay VA, Blay G, et al. Extracurricular physical activity participation modifies the association between high TV watching and low bone mass. Bone. 2009; 45 (5):925-930 - 60.
Sundquist K, Qvist J, Johansson S-E, Sundquist J. The long-term effect of physical activity on incidence of coronary heart disease: A 12-year follow-up study. Preventive Medicine. 2005; 41 (1):219-225 - 61.
Lim K, Wong CHM, Lee ALY, Fujikawa T, Wong RHL. Influence of cholesterol level on long-term survival and cardiac events after surgical coronary revascularization. JTCVS Open. 2022; 10 :195-203 - 62.
Lin H-P, Chen K-L, Chou W, Yuan K-S, Yen S-Y, Chen Y-S, et al. Prolonged touch screen device usage is associated with emotional and behavioral problems, but not language delay, in toddlers. Infant Behavior and Development. 2020; 58 (101424):101424 - 63.
Blanc P, Freyssin C, Rivière F, Mourot L, Benaich P, Boussuges A, et al. 264 Effect of the Wii sport boxing video game on the heart rate in cardiac rehabilitation patients. Achieves of Cardiovascular Diseases Supplement. 2011; 3 (1):87 - 64.
Krath J, Schürmann L, von Korflesch HFO. Revealing the theoretical basis of gamification: A systematic review and analysis of theory in research on gamification, serious games and game-based learning. Computer Humanan Behavior. 2021; 125 (106963):106963 - 65.
Zainuddin Z, Chu SKW, Shujahat M, Perera CJ. The impact of gamification on learning and instruction: A systematic review of empirical evidence. Education Research Review. 2020; 30 (100326):100326 - 66.
Keepers M, Nesbit I, Romero D, Wuest T. Current state of research & outlook of gamification for manufacturing. Journal of Manufacturing Systems. 2022; 64 :303-315 - 67.
Liu S, Zou S, Zhang D, Wang X, Wu X. Problematic Internet use and academic engagement during the COVID-19 lockdown: The indirect effects of depression, anxiety, and insomnia in early, middle, and late adolescence. Journal of Affective Disorders. 2022; 309 :9-18 - 68.
Shapira NA, Goldsmith TD, Keck PE Jr, Khosla UM, McElroy SL. Psychiatric features of individuals with problematic internet use. Journal of Affective Disorders. 2000; 57 (1-3):267-272 - 69.
Sharma MK, Hallford DJ, Anand N. Psychometric evaluation of the internet addiction test in India. Asian Journal of Psychiatry. 2022; 73 (103136):103136 - 70.
Lei L, Yang Y. The development and validation of adolescent pathological Internet use scale. Xin Li Xue Bao. 2022; 39 (04):688 - 71.
Chen S-H, Weng L-J, Su Y-J, Wu H-M, Yang P-F. Development of a Chinese Internet Addiction Scale and its psychometric study. Chinese Journal of Psychology. 2003; 45 (3):279-294 - 72.
Meerkerk G-J, Van Den Eijnden RJJM, Vermulst AA, Garretsen HFL. The Compulsive Internet Use Scale (CIUS): Some psychometric properties. Cyberpsychology Behavior. 2009; 12 (1):1-6