Impacts of Narrative, Nurturing, and Game-Play on Health-Related Outcomes in an Action-Adventure Health Game

Debra Lieberman

NOTE: This paper was selected by the program committee as a Meaningful Play 2008 Top Paper. It has been submitted to the Meaningful Play 2008 Special Issue of the International Journal of Gaming and Computer-Mediated Simulations (IJGCMS), which will be available in July-September 2009 issue. Due to the copyright requirements of the journal, only the abstract is available in the conference proceedings.


Narrative in digital interactive games, with engaging characters and dramatic stories, may serve many functions, such as increasing players' immersion and involvement in the game, boosting their attention and arousal, and enhancing learning and persuasion. How might the presence of a dramatic story line influence the appeal and health-related outcomes of an action-adventure health game? Likewise, how are players impacted when they nurture characters in the game who have health problems? And also, if narrative and nurturing are minimized in the game so that players focus on pure game-play instead, what are the strengths and weaknesses of this approach in achieving health-related outcomes? This paper reports findings from a study of the cancer education game, Re-Mission, which was modified into five versions with varying levels of narrative and nurturing. A randomized study of 488 young adults compared the impacts of the five game versions on health outcomes including players' cancer-related knowledge, attitudes, emotions, self-concepts, self-efficacy, information seeking, and intentions to prevent and treat cancer. The study found distinct strengths of narrative, nurturing, and pure game-play, and these findings provide useful evidence to guide the design of future health games.