A Board Game for Children with Hemophilia: Find Professor Tapps

Do serious games for health HAVE to be digital? No! The aim is to use game design approaches to educate and train. Analog games such as board and card games can be a perfect solution in many contexts. They are also really fun to make and have benefits over digital games.

Ready Rufus: Find Professor Tapps is a board game for young children with hemophilia and their families that I worked on.

Here’s how it happened, what we did, what we learned, and how board games for health have an edge over digital games.

What is Hemophilia

To give you some basic background, hemophilia is a genetically inherited condition mostly affecting males and is often discovered when they are very young. People with hemophilia lack a clotting factor in their blood which stops it from bleeding. Treatments have improved life expectancy and other outcomes, but many can be painful for young children. In addition to treatments, young children with hemophilia have to avoid activities with where there is a high risk for injuries (e.g., boxing, rugby). At the same time, patients work with physical therapists to ensure they are active and strong, especially around the joints, to avoid injuries and prevent unexplained bleeding.

How It All Started

I was Chair of the Games for Health UK Conference in 2016 when I was Professor of Serious Games at Coventry University. Alex Tarling, founder of Aktiv Technology and a user experience expert, approached me during an intermission between sessions. He was helping Pfizer work on a digital game project to address needs of young patients with hemophilia. Their early interviews with clinicians revealed that developing relevant skills for young patients with hemophilia inherently needed to involve their family members. A multiplayer game therefore made sense.

Knowing that multiplayer digital games could be expensive and complex, Alex thought that a physical board game might be just as much fun and an easier way to impact patients and family members. He thought my team and I might be able to partner with them to make a fun and impactful board game based on research. I had always wanted to work on an analog board game for health. I was all in.

Alex Tarling pitched the idea of a hemophilia board game instead of a digital game to Pfizer. It fit in well with an ongoing initiative they were working on to provide non-clinical support for children with rare diseases, especially hemophilia. They especially liked the idea of using a research evidence base to back up a playful game approach to help these patients and their families. We got the green light!

Research

My colleagues and I at Coventry University kicked of the project by doing rigorous background research to inform the focus of the board game. We conducted a systematic review and meta-analysis of published research on evaluating the effects of board games for health on various outcomes. This research (published in Games for Health) gave us a solid idea of what a board game could do for players. We were confident that we had a good chance of impacting knowledge as well as some health-related behaviors with a board game approach.

We also reviewed the research literature on non-medical interventions for patients with hemophilia. This review reassured us that supporting the needs of very young patients with hemophilia and their families would be a unique and very much needed contribution (note: this paper is currently under review for publication).

In addition to understanding the research literature, we also conducted research with key stakeholders to get the most updated and relevant advice. We collected data in one-on-one interviews, focus groups, user tests, and surveys with healthcare professionals (psychologists, nurses, physicians) and the target group of patients and their family members. These efforts helped us translate our “cold” research findings into more meaningful and appealing content for the game.

Play Testing (P. Kato joining remotely on the iPad)

Design

I worked on the basic game design using “Snakes and Ladders” as a basic board game approach. In addition, players had to answer questions correctly if they landed on certain spaces to win Factor cards that they could keep and use later to get ahead or protect them from slipping backwards in the game (a metaphor for clotting Factor in their blood). Here’s my very first stab at the layout of the game.

P. M. Kato Early Game Sketch for Board Game — Ready Rufus: Find Professor Tapps

A talented design team in London (DDB) stepped in to make the the visual design consistent with other material they were developing for the patients. They introduced visually engaging characters (Rufus and Louis) that had a backstory. They also introduced imaginative concepts (the Slippery Slopes and the Leaky Lakes) in the visuals of the board game to keep the young players engaged even when it wasn’t their turn in the game.

What We Learned

Here are a few basic design rules we found were relevant to serious game health whether they are digital or analog (board) games.

  1. KEEP IT SIMPLE! Have a basic game mechanic (e.g., roll dice and travel forward the number of places on the dice) that people can grasp quickly and get started right away. The flow of the game, the goal, and the rules should be as visually intuitive as possible so that the need to refer to an instruction manual or tutorial is minimized. Challenges in the game are necessary for engagement and should be relevant (e.g., answering questions correctly, strategizing moves). However, unnecessary challenges (e.g., not knowing which direction to move on the board, not understanding what an icon means in a game), should be addressed as much as possibly visually (e.g. arrows). Requiring users to refer to textual instructions (e.g., “always move in a counter-clockwise direction across the board) unnecessarily promotes a feeling of complexity.
  2. BALANCE! The most challenging but fun part of designing games for me is balancing the needs and capabilities of range of players. A good game needs to feel simple and easy to play (see above). The challenge is that it also needs to be complex and interesting enough for more advanced players. Our play testing with families of young patients (ages 6 to 11) and their family members suggested that we were able to do this with Ready Rufus. The young players particularly enjoyed it when the disease-related content was presented in a fun way (e.g., What should you remember to take with you when you spend the night with a friend? 1] a tooth brush or 2] a toilet brush). Parents enjoyed the opportunity to discuss the content of cards related to the history of hemophilia or how to talk about it with each other.
  3. IT IS HARD TO MAKE LEARNING FUN! While we want players to really enjoy playing the game and have fun, being confronted with things you don’t know is often not “fun” for people. We did a user test in which we asked patients, family members and clinicians to answer the questions on the game cards (we could see if they got the answer right or not), rate how hard each question was and tell us if they thought the card should be included in the final game or thrown out. There was a very strong tendency for people to want to throw out the cards that they as individuals answered incorrectly and/or thought were too hard. However, if we only included questions that people knew the answers to, they wouldn’t learn anything new! This is a ubiquitous challenge in creating serious games. We used a combination of keeping things simple (#1 above) and balancing challenge with fun (#2 above) to address this issue in the best possible way.

BENEFITS OF BOARD GAMES

In addition to the commonalities outlined above, we experienced some major benefits of working on a board game for health compared to a digital game.

  1. Quicker development, turnaround, and delivery. Implementing and making changes to art and game design can happen very quickly and more easily with a smaller team compared to digital games.
  2. Minimal concerns about adverse effects. There were virtually no concerns about screen time, addiction, isolating behaviors, eye strain, or carpal tunnel syndrome that arose during this project. We did make sure the game pieces conformed to international size standards to avoid risks of choking.
  3. User enthusiasm for delivering an activity away from screens. Several parents and family members thanked us for making something that the whole family could play together and did not require their child to focus on a screen.

The Game Today

Ready Rufus: Find Professor Tapps has already seen international acclaim. It won a PM Society Silver Craft Award in 2018 and a Silver Medal in the Serious Play Award Competition in 2019. It was also presented with my other games for health in the First Grand Exhibition of “Play Beyond the Game”at the Chinese Academy of Fine Arts Museum in Beijing, China in 2018.

If you’re interested in finding out more about Ready Rufus: Find Professor Tapps, please contact James Steed (James.Steed@pfizer.com).

References

Gauthier, A., Kato, P. M., Bul, K. C., Dunwell, I., Walker-Clarke, A., & Lameras, P. (2019). Board games for health: A systematic literature review and meta-analysis. Games for Health Journal, 8(2), 85-100. http://doi.org/10.1089/g4h.2018.0017

Mary Anne Liebert (2018, October 22). Preliminary evidence for use of board games to improve knowledge in health outcomes. Medical Press. Retrieved 3 December 2018 from https://medicalxpress.com/news/2018-10-preliminary-evidence-board-games-knowledge.html

Sue Wang (2018, September 12). How to Review “Games” in a New Perspective: The First Grand Exhibition “Play Beyond the Game” was unveiled at CAFAM. CAFA Newsletter. http://en.cafa.com.cn/how-to-review-games-in-a-new-perspective-the-first-grand-exhibition-play-beyond-the-game-was-unveiled-at-cafam.html

You can cite this article as:

Kato, P. M. (2019, March 01). A Board Game for Children with Hemophilia: Find Professor Tapps [Blog post]. Retrieved from https://wordpress.com/post/pamkato.com/8341

“Re-Mission: That story has legs!”

When Pam Omidyar and I first met back in 1999 and started HopeLab officially in 2001, I don’t think we ever imagined that her idea of a game for kids with cancer would turn into the success that we have seen with Re-Mission. We actually completed the game in 2005. We did research on it with 34 hospitals in the United States, Canada and Australia the following year. We released Re-Mission at the end of 2006 when we announced the finding we got at a conference. To date, over 200,000 copies of the game have been distributed in 81 countries across the world. 

I keep in touch with Richard Tate who is the Director of Communications at HopeLab, the non-profit company I co-founded with Pam Omidyar back in 2001. When I expressed my amazement not just at Re-Mission’s continued popularity as a serious game but the media’s continued fascination with it, he said, “Yes. That story has legs!”  In journalism when a story has legs, it lasts for a long time. The story about Re-Mission sure does have legs!

I recently did a video interview with Ben Rooney of the Wall Street Journal. In this you can hear why I think Re-Mission has been so successful for so long. (Click here to link to the story and video.)

In summary, I think it is a combination of three factors.

#1 The high production factors of the game which means not just the artistic value but the design approach that combined serious learning and behavior goals with fun gameplay. It is by now an old PC game and the controls aren’t perfect but you do feel immersed inside the human body and engaged in the story of Roxxi the nanobot fighting cancer in young patients, which brings me to the second point…

#2 The concept is brilliant. Too many people mistakenly think I came up with the concept but I didn’t. It was Pam Omidyar’s dream to make a game for kids with cancer where you go inside the body and engage in the fight against cancer by shooting cancer cells. Pam O.’s goal was to engage kids in an epic battle against cancer in the game. Epic games are what Jane McGonigal says engage people on a large scale and help them feel part of something bigger than themselves. It’s almost a spiritual experience. I think Re-Mission does that. 

#3 As I say in the video, Re-Mission is still popular and people are talking about it because we did research on it. This made the game much more than an amusing and entertaining distraction for kids with cancer. The research findings confirmed that this game was actually a powerful tool in the fight against cancer. The game “worked.” Kids who played the game took more of their antibiotics and oral chemotherapy as prescribed by their doctors than kids who just played a control game. I don’t think anyone would be talking to us today if we didn’t have these research findings. It wasn’t just a fun game where you shoot cancer cells. It was something that led you to do things in the real world like take your medication more regularly so that you could actually beat YOUR cancer, not just the cancer of a character in a game. 

Overall, I think we need to make really great serious games that combine our serious goals with fun and we need to make sure we do good research on them.

It’s not easy but it can be done. And we can change the world with serious games. That is OUR epic battle!