Many of the previous intervention programs for preventing obesity,3
or enhancing physical activity27
have not been successful among children. Within the context of the MMVM and video game interventions, the primary focus of this article is to explain that lack of effect is the linkage from the video game implementation of intervention procedures to desired mediating variable change. Attracting and maintaining a child’s attention may be the biggest contribution of video games to health-related behavior change, but this has not been demonstrated.
The effect of each of the proposed intervention procedures identified in on the corresponding mediating variable needs to be tested with different groups, under different circumstances, using alternative versions of the procedure. Do the procedures change the mediating variable enough to expect changes in the targeted behavior? And is the behavior change enough to influence the health outcome (e.g., obesity)? How can the design of the procedures (e.g., goal setting, tailored messaging, story components) be optimized to maximize the effect on the mediators (e.g., self-efficacy, outcome expectancy/attitudes, intrinsic motivation, practical knowledge)? To what extent do changes in the virtual situation (e.g., problem–solution identification) change the mediating variable (e.g., problem-solving behavior) to be operative in the real world in which the child functions? Or does the child need to personally face real-world challenges to enhance real-world problem solving skills?
The sequence of mediating variables in reflect a logical rendering of how these influences should work, but there has been no research to confirm how they actually work. It is possible that some of these mediating variables are out of sequence, that others are not really that important, or that there are key variables not included in this sequence. Research is needed on all these issues.
A key attractive feature of video game play is the fun or enjoyment from playing the game. Research is needed to identify what makes game play fun, e.g., active involvement/interactivity, overcoming challenges, making virtual choices, receiving consequences without real personal threat, personally relevant story, or characters immersed in personally meaningful situations. Can fun be used to promote behavior change, treating fun as a reward (e.g., unlocking new games as behaviors change), or by having a desirable character meet and model overcoming challenges to behavior change that a player is likely to face?
Other research questions include (a) whether mastery learning procedures (e.g., repeated testing until a preset learning criterion is attained) in a game enhance learning of practical knowledge necessary to change a behavior; (b) whether immersion in a story focuses attention, and thereby enhances central processing, on the behavior-change message; (c) whether there are groups of children among whom these intervention procedures work, or work better (e.g., children who play many games); and (d) how an intervention can be optimally designed for the others.