The use of serious digital games to talk about grief and finitude with children: reports on the design and evaluation process of two games

Aline Elias Cardoso Verhalen; Kamila Rios da Hora Rodrigues

doi:10.5753/jis.2024.4101

Authors

Aline Elias Cardoso Verhalen University of São Paulo https://orcid.org/0000-0002-8118-2584
Kamila Rios da Hora Rodrigues University of São Paulo https://orcid.org/0000-0001-9176-8709

DOI:

https://doi.org/10.5753/jis.2024.4101

Keywords:

Therapeutic Digital Games, Design, Evaluation, Death, Grief, Palliative care, Storytelling, RUFUS platform

Abstract

The discussion of grief and loss is often avoided, particularly when it comes to conversations involving children. The COVID-19 pandemic has tragically resulted in the loss of relatives and friends for thousands of children, bringing this topic to the forefront. Parents and caregivers have found themselves compelled to broach the subjects of death and grief with children, aiming to provide them with an understanding of the global events unfolding around them. Yet, such discussions remain steeped in taboo. Literature underscores the significance of addressing children's emotions during times of loss, offering guidance on how to navigate such experiences to mitigate the risk of long-term trauma in adulthood. This project introduces the development of two serious games tailored to assist health professionals in (1) guiding children through grief therapies and (2) initiating discussions about finitude with this specific audience. Using the SemTh methodology, which guides the design and evaluation of therapeutic digital games, a multidisciplinary team comprising Health professionals (psychologists and occupational therapists), as well as Computing professionals collaborated on the creation of these games. Implemented on the RUFUS platform, developed by these authors' research group, this platform utilizes predefined templates to guide the game instantiation. Notably, the project contributed two new templates to the platform: narrative and inverse narrative, enabling the construction of games through storytelling. The new templates on the RUFUS platform were assessed through empirical and analytical studies to allow usability and effectiveness of them.

Downloads

Download data is not yet available.

References

Bradley, M. M. and Lang, P. J. (1994). Measuring emotion: the self-assessment manikin and the semantic differential. Journal of behavior therapy and experimental psychiatry, 25(1):49–59. DOI: https://doi.org/10.1016/0005-7916(94)90063-9.

Brooke, J. (2013). Sus: a retrospective. Journal of usability studies, 8(2):29–40. Available at: [link].

Chai, C. W. E., Lau, B. T., Tee, M. K. T., and Al Mahmud, A. (2022). Evaluating a serious game to improve childhood cancer patients’ treatment adherence. Digital Health, 8:20552076221134457. DOI: https://doi.org/10.1177/20552076221134457.

da Hora Rodrigues, K. R., Darin, T. d. G. R., and de Almeida Neris, V. P. (2022). Building your own games: A platform for authoring digital games. In 2022 21st Brazilian Symposium on Computer Games and Digital Entertainment (SBGames), pages 1–6. IEEE. DOI: https://doi.org/10.1109/SBGAMES56371.2022.9961073.

da Hora Rodrigues, K. R., Elias Cardoso Verhalen, A., Willian da Silva, J., Marino Silva, T., Geurgas Zavarizz, R., de Almeida Neris, V. P., and Maia de Souza, P. (2023). Design and evaluation of an authoring platform for therapeutic digital games. Interacting with Computers, page iwac045. DOI: https://doi.org/10.1093/iwc/iwac045.

de Almeida Silva, L. C., Gracindo, R. F., Calheiros, M. I. F., de Oliveira, V. F., and de Souza, J. P. G. (2018). O efeito terapêutico do ato de ouvir e contar histórias em um setor de tratamento oncológico: relato de experiência. Gep News, 1(1):38–43. Available at: [link].

de Melo Pinheiro, T. S., Valério, C. C., Maciel, C., da Hora Rodrigues, K. R., and dos Santos Nunes, E. P. (2021). Revisiting empathy games concept from user comments perspective. In Proceedings of the XX Brazilian Symposium on Human Factors in Computing Systems, pages 1–11. DOI: https://doi.org/10.1145/3472301.3484359.

de Souza, P. M., Rodrigues, K. R. d. H., and de Almeida Neris, V. P. (2019). Semth: An approach to the design of therapeutic digital games. In Proceedings of the 18th Brazilian Symposium on Human Factors in Computing Systems, pages 1–11. DOI: https://doi.org/10.1145/3357155.3358440.

Del Pino, C. and Pereira, V. T. (2017). Ludoterapia durante o tratamento contra o câncer infantil: revisão integrativa de literatura. Revista Psicologia em Foco, 9(14):26–44.

Dutra, T., Maschio, E., and Gasparini, I. (2023). Pensar e lavar: Processo de desenvolvimento e avaliação de um jogo digital educacional para promover o pensamento computacional para crianças neurotípicas e com deficiência intelectual. Revista Brasileira de Informática na Educação, 31:659–690. DOI: https://doi.org/10.5753/rbie.2023.3330.

Fiorini, J. J. and Mullen, J. A. (2006). Understanding grief and loss in children. Vistas Online, pages 31–33. Available at: [link].

Fleming, G. G. S. (1998). A comparison of spousal anticipatory grief and conventional grief. Death Studies, 22(6):541–569. DOI: https://doi.org/10.1080/074811898201399.

Galvão, V. F., Maciel, C., and Da Hora Rodrigues, K. R. (2024a). How to promote empathy in games? an analysis of the structural elements to be considered in the interaction design. In Proceedings of the XXII Brazilian Symposium on Human Factors in Computing Systems, IHC ’23, New York, NY, USA. Association for Computing Machinery. DOI: https://doi.org/10.1145/3638067.3638073.

Galvão, V. F., Maciel, C., Dos Santos Nunes, E. P., and Da Hora Rodrigues, K. R. (2024b). A framework to support the development of empathic games. In Proceedings of the XXII Brazilian Symposium on Human Factors in Computing Systems, IHC ’23, New York, NY, USA. Association for Computing Machinery. DOI: https://doi.org/10.1145/3638067.3638104.

Garcia, F. E., Brandão, R., Cheban, G., and Neris, V. A. (2019). Co-criação inclusiva de jogos digitais baseados em storytelling apoiada por um framework em um centro de atenção psicossocial álcool e drogas. In Anais Estendidos do XVIII Simpósio Brasileiro sobre Fatores Humanos em Sistemas Computacionais, pages 180–181. SBC. DOI: https://doi.org/10.5753/ihc.2019.8429.

Garcia, F. E., da Hora Rodrigues, K. R., and de Almeida Neris, V. P. (2016). An interaction modeling language for therapeutic applications. In Proceedings of the 15th Brazilian Symposium on Human Factors in Computing Systems, pages 1–10. DOI: https://doi.org/10.1145/3033701.3033733.

Garcia-Schinzari, N. R., Pfeifer, L. I., Sposito, A. M. P., Santos, J. L. F., Nascimento, L. C., and Panúncio-Pinto, M. P. (2014). Caixas de histórias como estratégia auxiliar do enfrentamento da hospitalização de crianças e adolescentes com câncer/the use of story boxes as an adjuvant strategy to cope with hospitalization of children and adolescents with cancer. Cadernos Brasileiros de Terapia Ocupacional, 22(3). DOI: https://doi.org/10.4322/cto.2014.079.

Gonzalez, C. L. and Bell, H. (2016). Child-centered play therapy for hispanic children with traumatic grief: Cultural implications for treatment outcomes. International Journal of Play Therapy, 25(3):146. DOI: https://doi.org/10.1037/pla0000023.

Guerney, L. (2001). Child-centered play therapy. International Journal of Play Therapy, 10(2):13. DOI: https://doi.org/10.1037/h0089477.

Hoffmann, S., Schraut, R., Kröll, T., Scholz, W., Belova, T., Erhardt, J., Gollmer, D., Mauck, C., Zacharioudakis, G., Meyerheim, M., et al. (2021). Aquascouts: epros implemented as a serious game for children with cancer to support palliative care. Frontiers in Digital Health, 3. DOI: https://doi.org/10.3389/fdgth.2021.730948.

Karns, J. T. (2002). Children’s understanding of death. Journal of Clinical Activities, Assignments Handouts in Psychotherapy Practice, 2(1):43–50. DOI: https://doi.org/10.1300/J182v02n01_05.

Kübler-Ross, E. (1973). On death and dying. Routledge. Lieberman, H., Paternò, F., Klann, M., and Wulf, V. (2006). End-User Development: An Emerging Paradigm. End User Development, pages 1–8. DOI: https://doi.org/10.1007/1-4020-5386-X_1.

Maciel, C., de Souza, P. C., Lima, L., and dos Anjos, A. M. (2014). Objetos educacionais, parceria FNDE-UFMT. UFMT. Cuiabá: UFMT, Secretaria de Tecnologias da Informação Aplicadas à Educação, Book.

Madeira, R. N., Correia, N., Dias, A. C., Guerra, M., Postolache, O., and Postolache, G. (2011). Designing personalized therapeutic serious games for a pervasive assistive environment. In 2011 IEEE 1st International Conference on Serious Games and Applications for Health (SeGAH), pages 1–10. IEEE. DOI: https://doi.org/10.1109/SeGAH.2011.6165465.

Muri, M., Carvalho, R., Silva, T., Rodrigues, K., and Darin, T. (2022). Boas práticas para o design de jogos sérios em ferramentas de autoria eud. In Anais Estendidos do XXI Simpósio Brasileiro de Fatores Humanos em Sistemas Computacionais, pages 92–95. SBC. DOI: https://doi.org/10.5753/ihc_estendido.2022.224866.

Netto, I. S. B., Leite, C. Q., Gonzales, T. S., da Silva, C. S., dos Santos, A. D. S. P., Ferreira, Y. Q., de Negreiros, M. E. R., Lérias, B. Y. B., and dos Santos, B. F. (2022). A ludoterapia no tratamento oncológico infantil. Revista Eletrônica Acervo Saúde, 15(7):e10605–e10605.

Nishikawa, D., Novak, L., Azevedo, M., Branco, P., Olivi, R., Brandão, R., Garcia, F., and Neris, V. (2016). Se cuidar, cuidar de algo, se divertir e aprender fazem bem. Demonstração de um jogo para apoiar o tratamento da depressão.

Robin, B. (2006). The educational uses of digital storytelling. In Society for Information Technology & Teacher Education International Conference, pages 709–716. Association for the Advancement of Computing in Education (AACE). Available at: [link].

Rodrigues, K. R., Conrado, D. B., and Neris, V. P. (2018). Lessons learned in designing a digital therapeutic game to support the treatment and well-being of children with cancer. In International Conference of Design, User Experience, and Usability, pages 231–243. Springer. DOI: https://doi.org/10.1007/978-3-319-91806-8_18.

Rodrigues, K. R., Valério, C. C., Pinheiro, T. S., Maciel, C., and Nunes, E. P. (2021a). Diretrizes para o design de jogos empáticos. In Anais Estendidos do XX Simpósio Brasileiro de Jogos e Entretenimento Digital, pages 86–95. SBC. DOI: https://doi.org/10.5753/sbgames_estendido.2021.19628.

Rodrigues, K. R. d. H., Neris, V. P. d. A., Zavarizz, R. G., Silva, J. W. d., Silva, T. M., Verhalen, A. E. C., and Souza, P. M. d. (2022). Criando jogos digitais terapêuticos a partir da plataforma de autoria rufus. Anais Estendidos. DOI: https://doi.org/10.5753/ihc_estendido.2022.225290.

Rodrigues, K. R. d. H., Silva Junior, J. M., Nespule, L., Maia, M. S., Garcia, L. E., and Galati, H. B. (2020). Lume: Um jogo digital para incentivar a leitura de lendas do folclóre brasileiro. Anais. Available at: [link].

Rodrigues, K. R. d. H., Souza, P., Zavarizz, R., da Silva, J., Silva, T., Verhalen, A., and Neris, V. (2021b). Rufus - uma plataforma para autoria de jogos digitais terapêuticos. In CLIHC-X Latin American Conference on Human Computer Interaction. DOI: https://doi.org/10.1145/3488392.3488407.

Santos, D. B. d., Maciel, C., Pereira, V. C., and Nunes, E. P. d. S. (2018). Analysis of the perception of users of empathic games in discussion forums and their relation to death. In Proceedings of the 17th Brazilian Symposium on Human Factors in Computing Systems, pages 1–10. DOI: https://doi.org/10.1145/3274192.3274198.

Santos, R. C. S., Yamamoto, Y. M., and Custódio, L. M. G. (2017). Aspectos teóricos sobre o processo de luto e a vivência do luto antecipatório. Psicologia, pages 1–18. Available at [link].

Santos dos Santos, S., Modesto Campos, E., and da Hora Rodrigues, K. R. (2022). Emoframe: Prototype of a framework to assess users’ emotional responses. In HCI International 2022 - Late Breaking Papers. Design, User Experience and Interaction: 24th International Conference on Human-Computer Interaction, HCII 2022, Virtual Event, June 26 – July 1, 2022, Proceedings,

page 282–301, Berlin, Heidelberg. Springer-Verlag. DOI: https://doi.org/10.1007/978-3-031-17615-9_20.

Silva, T. M. (2022). Design, desenvolvimento e avaliação do jogo de narrativa invertida para a plataforma rufus. Available at: [link].

Sommerville, I. (2011). Engenharia de Software. ed. São Paulo, SP: Pearson Prentice Hall. Book.

Susi, T., Johannesson, M., and Backlund, P. (2007). Serious games: An overview. Available at: [link].

Tumolo, C. H. S. (2015). Histórias digitais como recurso para ensino/aprendizagem de inglês como língua estrangeira. Revista Estudos Anglo-Americanos, (43):101–117. Available at: [link].

VanEck, R. (2006). Digital game-based learning: It’s not just the digital natives who are restless. EDUCAUSE review, 41(2):16. Available at: [link].

Verhalen, A. E. C. (2022). Design de Jogos Digitais Terapêuticos que Apoiam o Diálogo com Crianças sobre a Morte. PhD thesis, Universidade de São Paulo. Dissertação. Available at: [link].

Verhalen, A. E. C., Pereira, V. C., Bim, S. A., de Picoli, R. M. d. M., Maciel, C., and Rodrigues, K. R. d. H. (2021). Jungle party - a game about loss and grief. In IHC ’21: Brazilian Symposium on Human Factors in Computing Systems. DOI: https://doi.org/10.1145/3472301.3484364.

Verhalen, A. E. C. and Rodrigues, K. R. D. H. (2023). Design of therapeutic digital games that support dialogue with children about death. In Proceedings of the XXII Brazilian Symposium on Human Factors in Computing Systems, pages 1–8. DOI: https://doi.org/10.1145/3638067.3638112.

Verhalen, A. E. C., Silva, T. M., and Rodrigues, K. R. D. H. (2023). Once upon a time... you! a game to support health professionals in the treatment of children with chronic diseases, helping them to express their feelings. In Proceedings of the XXII Brazilian Symposium on Human Factors in Computing Systems, pages 1–10. DOI: https://doi.org/10.1145/3638067.3638129.

Verhalen, A. E. C., Zavarizz, R. G., Silva, J. W. d., Silva, T. M., Nunes, C. E. P., de Gois Ribeiro Darin, T., and Rodrigues, K. R. d. H. (2022). Telling your own story: design and evaluation of a storytelling mechanic in a platform for serious games authoring. In Proceedings of the 21st Brazilian Symposium on Human Factors in Computing Systems, pages 1–7. DOI: https://doi.org/10.1145/3554364.3561610.

Wong, F. K. C. (2013). Helping a child cope with loss by using grief therapy. Available at: [link].

Yazıcı Arıcı, E., Kalogiannakis, M., and Papadakis, S. (2023). Preschool children’s metaphoric perceptions of digital games: A comparison between regions. Computers, 12(7):138. DOI: https://doi.org/10.3390/computers12070138.