IEEE Consumer Electronics Magazine - July 2015 - 81

do rehabilitation, training physicians to perform difficult procedures, and improving continuing education practices for
health-care professionals.
Using digital games, especially for such targeted outcomes,
is a relatively new practice and can be expensive because of the
hardware and software development costs. Additionally, it can
be difficult to measure the outcomes and determine whether
the impact of the intervention was worth the outlay. The
Engender Games Group (EGG) Lab (engendergamesgroup.
com) has been working with young doctors on low-cost ways
to test game-based methods of modifying the behavior of
patients and health-care workers. EGG has worked with two
groups of physicians on initiatives of this kind, and both have
recently provided data on the results of the interventions and
the efficacy of the methodology.

FIGURE 1. Birth attendants in Morelos, Mexico, playing the Atendiendo game. (Photo courtesy of Adriana Villafuerte.)

IMPROVED NEONATAL/MATERNAL OUTCOMES
Carrie Rouse (medical resident) and Dilys Walker (mentoring
professor) at the University of Washington Medical School were
interested in the possibility of using a game to promote evidence-based practices among traditional birth attendants in rural
Mexico that can improve outcomes for both mother and neonate.
Given that literacy levels are low in this population, we hoped
that a game that communicated primarily through illustration
and audio and fostered emotional engagement by depicting a
woman in recognizable surroundings would be more successful
than other educational strategies.
Together with collaborators at the National Institute of Public
Health in Mexico (INSP), the physicians worked closely with
the developers over the course of game development. Testing on
the target population is very important during the design process,
but, given the fact that the test population was widely distributed
in rural Mexico, it was impossible to iteratively test the game.
Fortunately, colleagues at the INSP were able to capitalize on a
regular monthly training session for traditional birth attendants
and obtain permission to conduct a pilot study, and the game
team was able to get very useful feedback. The drawings were
changed to better reflect the reality of the birth environment and
the kinds of materials available (e.g., using new plastic garbage
bags to create a sanitary environment inside a home) and cultural
traditions (e.g., women often give birth partially clothed). We
also modified some of the audio scripts to reflect local idioms.
Rouse, who led the field testing, encountered numerous problems. We had considered several options for delivering the game
to the target audience and settled on using Flash software
because it worked reliably in any browser on any computer.
Rouse went to Mexico and picked up laptops from the INSP. To
extract the data from the browser and save it for analysis, she
had to install a Python script on each of the laptops. Given that
she had little computer experience, EGG lab developers and
technicians at the INSP coached her via Skype and dealt with
various technical difficulties. Once the installation was complete,
Rouse took the laptops to the rural town where the midwives had
gathered for training (Figure 1).
We had expected that the midwives might be uncomfortable
and/or unwilling to experiment with computer technology and

could possibly be offended by the graphic nature of the images. However, none of these issues materialized. The response
to the game was overwhelmingly positive. The biggest difficulty was that 76% of participants had never used a computer
before and had difficulty using a mouse to play the game.
Budget constraints and the nature of the material being communicated made it impossible to test for whether or not playing
the game actually changed the midwives' behavior in practice. We
hope to obtain funding for a larger project where we can see the
effect of game-based training over the long term. This pilot study
did demonstrate that this population was very open and willing to
engage in digital, game-like educational environments. We determined that, in the future, it would be easier to deliver the game on
tablets using touchscreen interfaces for maximum ease of use.

INCREASED VACCINATION RATES
A different project, this time with physicians at the Children's
Medical Center at Winthrop-University Hospital in Long Island,
New York, had a narrower focus and provided more specific data
about the potential efficacy of game-based interventions. Leonard
Krilov (mentoring physician) and his team (C. Halaby, A. Mock,
M. Pirzada, and R. Lee) worked with the EGG Lab to develop a

FIGURE 2. Winthrop Pediatric Associates patient Patrick Robinson
testing the Flu Busters game. (Photo courtesy of Leanna Cherry,
Winthrop-University Hospital.)

july 2015

IEEE Consumer Electronics Magazine

Table of Contents for the Digital Edition of IEEE Consumer Electronics Magazine - July 2015