Meta-analytic Review of Serious Games for Healthy Lifestyle Adoption: Comparison of Single Level and Multilevel Programs

Abstract

Background. Multilevel programs (containing individual and environmental influences) are often documented as most effective in health promotion. This study examines whether serious games which are part of a multilevel program are more effective than games focusing only on the individual. Methods. A meta-analysis was conducted of serious games for health promotion published before Aug 2013. Random effects model analyses were performed (Hedges’ g). Results. Sixty-seven studies were included, of which a minority (29%) were multilevel games. Both single level (g=.391) and multilevel games (g=.215) were effective, but surprisingly, single level games were more effective than multilevel games. However, when examining behavioral determinants separately, only for attitudes (Q(1)=10.553, p<.01 -note: small sample) single level games were significantly more effective than multilevel programs. No long-term differences were significant. Conclusions. Both single level and multilevel serious games are effective for health promotion. When targeting attitudes, single level games may be preferred. However, few multilevel serious games to date exist and more research on multilevel games is needed.